Provider Demographics
NPI:1154977858
Name:LOUIS, MARIE A
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:A
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 1:19 KNIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2421
Mailing Address - Country:US
Mailing Address - Phone:845-566-1412
Mailing Address - Fax:
Practice Address - Street 1:19 KNIGHTS CIR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2421
Practice Address - Country:US
Practice Address - Phone:845-566-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty