Provider Demographics
NPI:1851576375
Name:BROSNAN, MARYJO (LPN)
Entity Type:Individual
Prefix:MR
First Name:MARYJO
Middle Name:
Last Name:BROSNAN
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 1:50 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3412
Mailing Address - Country:US
Mailing Address - Phone:631-242-9287
Mailing Address - Fax:
Practice Address - Street 1:50 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3412
Practice Address - Country:US
Practice Address - Phone:631-242-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289062-1372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider