MEDICARE: JACQUELINE LABORIEL

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
1	164W00000X	Licensed Practical Nurse	298572	NY

General Provider Information

NPI Number	:	1851772685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE LABORIEL

Provider Business Mailing Address
First Line	:	340 BEEKMAN AVE
Second Line	:	4A
City	:	BRONX
State	:	NY
Zip	:	10454-1433
Country	:	US
Telephone Number	:	347-942-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 BEEKMAN AVE
Second Line	:	4A
City	:	BRONX
State	:	NY
Zip	:	10454-1433
Country	:	US
Telephone Number	:	347-942-3896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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Directions to “ JACQUELINE LABORIEL ” Practice Location

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