Provider Demographics
NPI:1245652171
Name:PIERRE-LOUIS, MARLEINE (LPN)
Entity type:Individual
Prefix:
First Name:MARLEINE
Middle Name:
Last Name:PIERRE-LOUIS
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 1:65 LIBERTY BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5019
Mailing Address - Country:US
Mailing Address - Phone:516-285-6621
Mailing Address - Fax:
Practice Address - Street 1:65 LIBERTY BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5019
Practice Address - Country:US
Practice Address - Phone:516-285-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275639-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY275639-1Medicaid