Provider Demographics
NPI:1104135839
Name:CONTEH, MARION LOGAN (ANP, BC)
Entity type:Individual
Prefix:MRS
First Name:MARION
Middle Name:LOGAN
Last Name:CONTEH
Suffix:
Gender:F
Credentials:ANP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 E 175TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-6802
Mailing Address - Country:US
Mailing Address - Phone:917-204-2261
Mailing Address - Fax:
Practice Address - Street 1:748 E 175TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6802
Practice Address - Country:US
Practice Address - Phone:917-204-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305338-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health