Provider Demographics
NPI:1316343783
Name:CHRISTIAN, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:YVANNE
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:194 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4123
Mailing Address - Country:US
Mailing Address - Phone:917-498-1124
Mailing Address - Fax:
Practice Address - Street 1:194 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4123
Practice Address - Country:US
Practice Address - Phone:917-498-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320081-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse