Provider Demographics
NPI:1144530346
Name:LAUSELL, MARIE I
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:I
Last Name:LAUSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B1 CALLE SAN ALVARO
Mailing Address - Street 2:SAN JUAN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5322
Mailing Address - Country:US
Mailing Address - Phone:787-758-1733
Mailing Address - Fax:787-763-9942
Practice Address - Street 1:B1 CALLE SAN ALVARO
Practice Address - Street 2:SAN JUAN GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5322
Practice Address - Country:US
Practice Address - Phone:787-758-1733
Practice Address - Fax:787-163-9942
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor