Provider Demographics
NPI:1629487418
Name:HALL LAWRENCE, MARILYN PATRICIA
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:PATRICIA
Last Name:HALL LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21921 143RD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3114
Mailing Address - Country:US
Mailing Address - Phone:646-619-7625
Mailing Address - Fax:
Practice Address - Street 1:21921 143RD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3114
Practice Address - Country:US
Practice Address - Phone:646-619-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318754164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse