Provider Demographics
NPI:1063711489
Name:ELYSEE, MARIE CARMEL (LPN)
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:CARMEL
Last Name:ELYSEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 CLARENDON RD
Mailing Address - Street 2:PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5213
Mailing Address - Country:US
Mailing Address - Phone:718-284-4801
Mailing Address - Fax:
Practice Address - Street 1:4305 CLARENDON RD
Practice Address - Street 2:PH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5213
Practice Address - Country:US
Practice Address - Phone:718-284-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291794-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse