Provider Demographics
NPI:1518604016
Name:WASHINGTON, MARLON D'ANDRE (RN)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:D'ANDRE
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1816
Mailing Address - Country:US
Mailing Address - Phone:845-323-8621
Mailing Address - Fax:
Practice Address - Street 1:20 HUGHES ST
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1816
Practice Address - Country:US
Practice Address - Phone:845-323-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY842845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse