Provider Demographics
NPI:1114712981
Name:LAGO, MARIE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LAGO
Suffix:
Gender:
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 E 147TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4104
Mailing Address - Country:US
Mailing Address - Phone:201-779-1666
Mailing Address - Fax:
Practice Address - Street 1:424 E 147TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4104
Practice Address - Country:US
Practice Address - Phone:201-779-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse