Provider Demographics
NPI:1902573090
Name:MARAH, LIMA (LPN)
Entity Type:Individual
Prefix:
First Name:LIMA
Middle Name:
Last Name:MARAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LIMA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:68 BLAYDON LOOP
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9804
Mailing Address - Country:US
Mailing Address - Phone:585-487-6243
Mailing Address - Fax:
Practice Address - Street 1:68 BLAYDON LOOP
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9804
Practice Address - Country:US
Practice Address - Phone:585-487-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNAMedicaid