Provider Demographics
NPI:1417264680
Name:MARSH, YONIQUE
Entity Type:Individual
Prefix:MRS
First Name:YONIQUE
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BAYCHESTER AVE
Mailing Address - Street 2:APT 3F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4402
Mailing Address - Country:US
Mailing Address - Phone:718-379-0772
Mailing Address - Fax:
Practice Address - Street 1:620 BAYCHESTER AVE
Practice Address - Street 2:APT 3F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4402
Practice Address - Country:US
Practice Address - Phone:718-379-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671839-1163W00000X
NY251516164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse