Marie Maude Thelisma, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

311387-1 Issued in NY

Practice address

13 Cleveland Street
Valley Stream, NY 11580

Phone

(718) 529-3019

Fax

(718) 529-3019

NPI assigned

Feb 5, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360022400000",
    "number": "1083953459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14539 LINDEN BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114361151",
            "telephone_number": "718-529-3019",
            "fax_number": "718-529-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CLEVELAND STREET",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "11580",
            "telephone_number": "718-529-3019",
            "fax_number": "718-529-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THELISMA",
        "first_name": "MARIE",
        "middle_name": "MAUDE",
        "name_prefix": "Miss",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-05",
        "last_updated": "2013-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "311387-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPN",
            "identifier": "311387-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.