Healthcare Provider Details

I. General information

NPI: 1932426178
Provider Name (Legal Business Name): LUNELLE JEANITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 E 83RD ST
BROOKLYN NY
11236-5101
US

IV. Provider business mailing address

1339 E 83RD ST
BROOKLYN NY
11236-5101
US

V. Phone/Fax

Practice location:
  • Phone: 347-636-1072
  • Fax: 347-636-1072
Mailing address:
  • Phone: 347-636-1072
  • Fax: 347-636-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number617545
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: