Provider Demographics
NPI:1992173322
Name:BLAKE-FORRESTER, MARRIA SYLVIA
Entity type:Individual
Prefix:
First Name:MARRIA
Middle Name:SYLVIA
Last Name:BLAKE-FORRESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARRIA
Other - Middle Name:
Other - Last Name:FORRESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:69 W GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6101
Mailing Address - Country:US
Mailing Address - Phone:516-933-0485
Mailing Address - Fax:
Practice Address - Street 1:69 W GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6101
Practice Address - Country:US
Practice Address - Phone:516-933-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse