Provider Demographics
NPI:1386967388
Name:MARRONE, KELLY A (LPN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:MARRONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5003
Mailing Address - Country:US
Mailing Address - Phone:845-724-6015
Mailing Address - Fax:
Practice Address - Street 1:18 CEDAR LN
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5003
Practice Address - Country:US
Practice Address - Phone:845-724-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286424-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse