Provider Demographics
NPI:1992157689
Name:LOUIS, MARIE (ADMINISTRATOR)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BURNING WICK PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8802
Mailing Address - Country:US
Mailing Address - Phone:386-631-0432
Mailing Address - Fax:
Practice Address - Street 1:19 BURNING WICK PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8802
Practice Address - Country:US
Practice Address - Phone:386-631-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906826376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator