Provider Demographics
NPI:1902386667
Name:ALEXANDRE, MARIE VANITA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:VANITA
Last Name:ALEXANDRE
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 1:134 FALLON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3610
Mailing Address - Country:US
Mailing Address - Phone:516-725-0569
Mailing Address - Fax:
Practice Address - Street 1:134 FALLON AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3610
Practice Address - Country:US
Practice Address - Phone:516-725-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259542164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse