Provider Demographics
NPI:1063788206
Name:CHAREST, MARIANNE ELIZABETH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:CHAREST
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 SEBONAC RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2743
Mailing Address - Country:US
Mailing Address - Phone:631-259-3828
Mailing Address - Fax:
Practice Address - Street 1:256 SEBONAC RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2743
Practice Address - Country:US
Practice Address - Phone:631-259-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337849-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse