Provider Demographics
NPI:1558562439
Name:CAZEAU, MARIE QUETLY (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:QUETLY
Last Name:CAZEAU
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 MANOR PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1545
Mailing Address - Country:US
Mailing Address - Phone:516-242-1926
Mailing Address - Fax:516-496-2139
Practice Address - Street 1:8 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4831
Practice Address - Country:US
Practice Address - Phone:516-496-7900
Practice Address - Fax:516-496-2139
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303671363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF303671OtherLICENSE
NYMC0909688OtherDEA
NYQ08188Medicare UPIN