Provider Demographics
NPI:1427484369
Name:EXANTUS, MARIE LESLIE M
Entity type:Individual
Prefix:
First Name:MARIE LESLIE
Middle Name:M
Last Name:EXANTUS
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 1:125 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1047
Mailing Address - Country:US
Mailing Address - Phone:917-513-5910
Mailing Address - Fax:
Practice Address - Street 1:125 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1047
Practice Address - Country:US
Practice Address - Phone:917-513-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse