Marie F Etienne

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

199161-1 Issued in NY

Practice address

158 Horseshoe Rd
Mill Neck, NY 11765

Phone

(516) 624-8797

NPI assigned

Oct 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marie F Jacques Former name

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": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1508045501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 SOUTHGATE RD",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "11581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 HORSESHOE RD",
            "city": "MILL NECK",
            "state": "NY",
            "postal_code": "11765",
            "telephone_number": "516-624-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "MARIE",
        "middle_name": "F",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-26",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "199161-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "01474693",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "JACQUES",
            "middle_name": "F",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan A. Antonellis, AU.D. CCC-A/F-AAA
• Liselotte Betetta, M.S., CCC-SLP
• Franince Atlas Bogdanoff
• Hilda Sharon Cooper
• Gianna Rose Fiorio
• Judith Ann Johanson, TSHH,TOD,SPEC. ED.
• Dawn Christine Kempa, RN, IBCLC
• Anne Kraemer
• Jami R Krug

• All providers in Mill Neck, NY
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; 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.