Provider Demographics
NPI:1457103376
Name:MARSEILLE, MIRIAM (LPN)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:MARSEILLE
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 1:130 HEMPSTEAD AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2156
Mailing Address - Country:US
Mailing Address - Phone:516-912-8777
Mailing Address - Fax:
Practice Address - Street 1:130 HEMPSTEAD AVE APT 402
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2156
Practice Address - Country:US
Practice Address - Phone:516-912-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332120-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse