Provider Demographics
NPI:1922373406
Name:LOUIS, MARIE CAROLLE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CAROLLE
Last Name:LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 E 88TH ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3251
Mailing Address - Country:US
Mailing Address - Phone:347-678-4642
Mailing Address - Fax:
Practice Address - Street 1:573 E 88TH ST
Practice Address - Street 2:1ST FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3251
Practice Address - Country:US
Practice Address - Phone:347-678-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309158164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse