Healthcare Provider Details

I. General information

NPI: 1710264387
Provider Name (Legal Business Name): LOVELY JEUDY-PIERRE R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LOVELY PASKA JEUDY-PIERRE RN

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21247 JAMAICA AVE SUITE 208
QUEENS VILLAGE NY
11428-1607
US

IV. Provider business mailing address

97-32 221 STREET
QUEENS VILLAGE NY
11429
US

V. Phone/Fax

Practice location:
  • Phone: 718-454-2038
  • Fax: 888-503-1828
Mailing address:
  • Phone: 718-217-5052
  • Fax: 888-503-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695295-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number6952959-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: