Provider Demographics
NPI:1598141376
Name:MARSICANO, KELLY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MARSICANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2618
Mailing Address - Country:US
Mailing Address - Phone:352-278-5561
Mailing Address - Fax:
Practice Address - Street 1:35 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2618
Practice Address - Country:US
Practice Address - Phone:352-278-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322622164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse