Provider Demographics
NPI:1891853651
Name:OTHONIEL, MARLENE MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:MARIE
Last Name:OTHONIEL
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:300 SKILLMAN AVENUE
Mailing Address - Street 2:LUTHERAN FAMILY HEALTH CTR, COMMUNITY MEDICINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211
Mailing Address - Country:US
Mailing Address - Phone:718-302-7366
Mailing Address - Fax:718-963-4016
Practice Address - Street 1:300 SKILLMAN AVE
Practice Address - Street 2:LUTHERAN FAMILY HEALTH CTR, COMMUNITY MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1607
Practice Address - Country:US
Practice Address - Phone:718-302-7366
Practice Address - Fax:718-963-4016
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF331094-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health