Provider Demographics
NPI:1861813917
Name:ROPER, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:ROPER
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 1:29 PONDVIEW
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3164
Mailing Address - Country:US
Mailing Address - Phone:917-602-8453
Mailing Address - Fax:
Practice Address - Street 1:29 PONDVIEW
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3164
Practice Address - Country:US
Practice Address - Phone:917-602-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316777-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse