MEDICARE: JANORA R VANLIEW

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	302344	NY

General Provider Information

NPI Number	:	1134427032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANORA R VANLIEW

Provider Business Mailing Address
First Line	:	1736 STRAIGHT PATH
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1920
Country	:	US
Telephone Number	:	631-575-1951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 STRAIGHT PATH
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1920
Country	:	US
Telephone Number	:	631-575-1951
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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Directions to “ JANORA R VANLIEW ” Practice Location

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