Provider Demographics
NPI:1730814468
Name:VALIQUETTE, MARCIA (LPN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:VALIQUETTE
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 1:159 HONEY SUCKLE LANE
Mailing Address - Street 2:
Mailing Address - City:GILBOA
Mailing Address - State:NY
Mailing Address - Zip Code:12076
Mailing Address - Country:US
Mailing Address - Phone:516-329-2341
Mailing Address - Fax:
Practice Address - Street 1:159 HONEY SUCKLE LANE
Practice Address - Street 2:
Practice Address - City:GILBOA
Practice Address - State:NY
Practice Address - Zip Code:12076
Practice Address - Country:US
Practice Address - Phone:516-329-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2024-10-29
Deactivation Date:2022-08-15
Deactivation Code:
Reactivation Date:2022-12-28
Provider Licenses
StateLicense IDTaxonomies
NY342759164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse