Provider Demographics
NPI:1689045585
Name:DREIZLER, MARIANNE
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:DREIZLER
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 1:12 MARIAN CT
Mailing Address - Street 2:12 MARIAN CT
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4044
Mailing Address - Country:US
Mailing Address - Phone:845-987-4377
Mailing Address - Fax:
Practice Address - Street 1:12 MARIAN CT
Practice Address - Street 2:12 MARIAN CT
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4044
Practice Address - Country:US
Practice Address - Phone:845-987-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315230-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse