Provider Demographics
NPI:1649339144
Name:MARRIOTT, PAULA NICOLE (RN)
Entity type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:NICOLE
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 BEACH 64TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1423
Mailing Address - Country:US
Mailing Address - Phone:718-318-0897
Mailing Address - Fax:
Practice Address - Street 1:10504 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5022
Practice Address - Country:US
Practice Address - Phone:718-725-5000
Practice Address - Fax:718-725-5804
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283322-1164W00000X
FLPN5161567164W00000X
NY616852163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse