Basic Information
Provider Information
NPI: 1003139338
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GORDON-BARRETT
FirstName: MARCIA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LPN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3696 HARPER AVE
Address2: PH
City: BRONX
State: NY
PostalCode: 104665907
CountryCode: US
TelephoneNumber: 9144133355
FaxNumber:  
Practice Location
Address1: 3696 HARPER AVE
Address2: PH
City: BRONX
State: NY
PostalCode: 104665907
CountryCode: US
TelephoneNumber: 9144133355
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/01/2010
LastUpdateDate: 06/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000X289156-1NYY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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