Provider Demographics
NPI:1790007045
Name:VICTOR, MARINA HARRY (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:HARRY
Last Name:VICTOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:HARRY
Other - Last Name:VICTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:968 MIDDLE BAY DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5042
Mailing Address - Country:US
Mailing Address - Phone:516-992-2438
Mailing Address - Fax:
Practice Address - Street 1:968 MIDDLE BAY DR
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-5042
Practice Address - Country:US
Practice Address - Phone:516-992-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse