Provider Demographics
NPI:1770849390
Name:HOWELL, MARK KEITH (LPN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEITH
Last Name:HOWELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W 87TH ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3070
Mailing Address - Country:US
Mailing Address - Phone:646-448-4025
Mailing Address - Fax:
Practice Address - Street 1:17 W 87TH ST APT 5B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3070
Practice Address - Country:US
Practice Address - Phone:646-448-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278525-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse