Provider Demographics
NPI:1427500032
Name:WASHINGTON, MARQUETTA (LPN)
Entity type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:
Last Name:WASHINGTON
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:PO BOX 8111
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06530-0111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:547 SAW MILL RIVER RD STE 3A
Practice Address - Street 2:SUITE 3A
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2142
Practice Address - Country:US
Practice Address - Phone:914-510-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse