MEDICARE: MRS. MARIE JOSIANE PACAUD LPN

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	320200-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YLK84777379	OTHER	NY	HEALTH PLAN (BLUE CROSS)

General Provider Information

NPI Number	:	1982000402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE JOSIANE PACAUD LPN

Provider Business Mailing Address
First Line	:	363 LINDEN BLVD
Second Line	:	4
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2724
Country	:	US
Telephone Number	:	347-792-4501
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 LINDEN BLVD
Second Line	:	4
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2724
Country	:	US
Telephone Number	:	347-792-4501
Fax Number	:

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

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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