Provider Demographics
NPI:1194422451
Name:TINKER-MANGROO, MARSHAREE
Entity type:Individual
Prefix:
First Name:MARSHAREE
Middle Name:
Last Name:TINKER-MANGROO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PRESCOTT PL APT 7F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-6979
Mailing Address - Country:US
Mailing Address - Phone:646-986-5450
Mailing Address - Fax:
Practice Address - Street 1:20 PRESCOTT PL APT 7F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-6979
Practice Address - Country:US
Practice Address - Phone:646-986-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345439-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty