Provider Demographics
NPI:1558604223
Name:NILES, MARSHA A (NP)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:A
Last Name:NILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3214
Mailing Address - Country:US
Mailing Address - Phone:516-868-3728
Mailing Address - Fax:
Practice Address - Street 1:215 ROCKAWAY TPKE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1216
Practice Address - Country:US
Practice Address - Phone:516-374-5024
Practice Address - Fax:516-792-0619
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306205363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health