Provider Demographics
NPI:1881964823
Name:MARSICO, JACQUELINE MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:MARSICO
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 1:67 BARCLAY PLAZA
Mailing Address - Street 2:APT. 3
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:845-787-4859
Mailing Address - Fax:
Practice Address - Street 1:67 BARCLAY PLAZA
Practice Address - Street 2:APT 3
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-787-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301518164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse