Provider Demographics
NPI:1962716134
Name:LOUIS-CHARLES, MARIE LUMENE (FNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LUMENE
Last Name:LOUIS-CHARLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:LUMENE
Other - Last Name:LOUIS-CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:27 N BALDWIN PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5525
Mailing Address - Country:US
Mailing Address - Phone:515-668-2872
Mailing Address - Fax:
Practice Address - Street 1:27 N BALDWIN PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5525
Practice Address - Country:US
Practice Address - Phone:515-668-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336114-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily