Provider Demographics
NPI:1962657007
Name:STEPHEN, MARIE ISABELLE-MATHIEU (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ISABELLE-MATHIEU
Last Name:STEPHEN
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 1:294 NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1637
Mailing Address - Country:US
Mailing Address - Phone:718-981-4259
Mailing Address - Fax:718-981-4259
Practice Address - Street 1:294 NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1637
Practice Address - Country:US
Practice Address - Phone:718-981-4259
Practice Address - Fax:718-981-4259
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255843-1374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel