Provider Demographics
NPI:1023015856
Name:OQUENDO-MILLER, MARIE (MSNP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:OQUENDO-MILLER
Suffix:
Gender:F
Credentials:MSNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSNP
Mailing Address - Street 1:50 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2039
Mailing Address - Country:US
Mailing Address - Phone:631-474-0263
Mailing Address - Fax:631-474-2329
Practice Address - Street 1:1 STADIUM ROAD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-632-6738
Practice Address - Fax:631-632-6936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255406363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health