Provider Demographics
NPI:1740898071
Name:KING, ARLYN ANDREA
Entity type:Individual
Prefix:
First Name:ARLYN
Middle Name:ANDREA
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARLYN
Other - Middle Name:ANDREA
Other - Last Name:LLERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 MCCORMICK PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2509
Mailing Address - Country:US
Mailing Address - Phone:347-933-0011
Mailing Address - Fax:
Practice Address - Street 1:11 MCCORMICK PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2509
Practice Address - Country:US
Practice Address - Phone:347-933-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY768566163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse