Provider Demographics
NPI:1447787650
Name:POLYCARPE, MARIE JESSIE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:JESSIE
Last Name:POLYCARPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 11TH ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4332
Mailing Address - Country:US
Mailing Address - Phone:917-273-7890
Mailing Address - Fax:
Practice Address - Street 1:11001 84TH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1247
Practice Address - Country:US
Practice Address - Phone:718-559-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399953-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health