Individual
ATHENA MAMANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4238 MERRICK RD, MASSAPEQUA, NY 11758-6016
(631) 868-3498
Mailing address
PO BOX 9, SMITHTOWN, NY 11787-0009
(631) 614-8690
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
345752-01
NY
Other
Enumeration date
02/21/2023
Last updated
02/21/2023
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