Provider Demographics
NPI:1689638009
Name:ANDERSON, MARLENE O (NP)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:O
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14554 229TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3923
Mailing Address - Country:US
Mailing Address - Phone:718-341-2278
Mailing Address - Fax:
Practice Address - Street 1:KINGS COUNTY HOSPITAL
Practice Address - Street 2:451 CLARKSON AVE, E BLDG-6TH FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-5484
Practice Address - Fax:718-245-3061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily