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NPI Code Detail

MEDICARE: LOURDES AGLAEE JEAN REGISTERED NURSE

MEDICARE: LOURDES AGLAEE JEAN REGISTERED NURSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WW0000XWound Care Registered Nurse506185NY

General Provider Information

NPI Number : 1770150526
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOURDES AGLAEE JEAN REGISTERED NURSE
Provider Business Mailing Address
First Line : 1711 BROOKHAVEN AVE
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4406
Country : US
Telephone Number : 718-869-8000
Fax Number :
Provider Business Practice Location Address
First Line : 1711 BROOKHAVEN AVE
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4406
Country : US
Telephone Number : 718-869-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2021
Last Update Date : 06/09/2021

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