Healthcare Provider Details

I. General information

NPI: 1437339991
Provider Name (Legal Business Name): JEANETTE CUSHION LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NW 183RD ST SUITE 400
MIAMI GARDENS FL
33169-4537
US

IV. Provider business mailing address

111 NW 183RD ST SUITE 400
MIAMI GARDENS FL
33169-4537
US

V. Phone/Fax

Practice location:
  • Phone: 305-892-4753
  • Fax: 305-493-0814
Mailing address:
  • Phone: 305-892-4753
  • Fax: 305-493-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN92291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: