Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 001064 | NY |
NPI | 1023108834 |
---|---|
Provider Name | Mrs. Marlyne Charles |
First Address | Huntington Station, NY 11746-1915 |
Second Address | Huntington Station, NY 11746-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02335720 | (05) | NY |