Provider Demographics
NPI:1679865133
Name:MIDGLEY, MARSHA (LPN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:MIDGLEY
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 1:2037 SEAGIRT BLVD
Mailing Address - Street 2:1D
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2945
Mailing Address - Country:US
Mailing Address - Phone:516-305-1497
Mailing Address - Fax:
Practice Address - Street 1:2037 SEAGIRT BLVD
Practice Address - Street 2:1D
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2945
Practice Address - Country:US
Practice Address - Phone:516-305-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303565-1164W00000X
NYF347050-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse