Provider Demographics
NPI:1649541913
Name:MARSEILLE, DIDENA S (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:DIDENA
Middle Name:S
Last Name:MARSEILLE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2104
Mailing Address - Country:US
Mailing Address - Phone:631-547-1830
Mailing Address - Fax:631-547-1830
Practice Address - Street 1:21 12TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-2104
Practice Address - Country:US
Practice Address - Phone:631-547-1830
Practice Address - Fax:631-547-1830
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY570364163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse