Provider Demographics
NPI:1871984575
Name:MALETTE, MARIE LESLIE (LPN)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LESLIE
Last Name:MALETTE
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 1:1185 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4628
Mailing Address - Country:US
Mailing Address - Phone:718-338-2831
Mailing Address - Fax:718-771-3873
Practice Address - Street 1:1185 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4628
Practice Address - Country:US
Practice Address - Phone:718-338-2831
Practice Address - Fax:718-771-3873
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313163164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse