Provider Demographics
NPI:1972069466
Name:VINCENT, MARYSE C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARYSE
Middle Name:C
Last Name:VINCENT
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 1:36 GREENWICH HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:914-886-8262
Mailing Address - Fax:
Practice Address - Street 1:36 GREENWICH HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:914-886-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294798-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse