MEDICARE: EDITH LOUIS-JUSTE 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	287295	NY

General Provider Information

NPI Number	:	1497079578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH LOUIS-JUSTE LPN

Provider Business Mailing Address
First Line	:	108 UNION RD
Second Line	:	APT. 2H
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-3446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 UNION RD
Second Line	:	APT. 2H
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-3446
Country	:	US
Telephone Number	:	845-426-5349
Fax Number	:

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

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	03/18/2010

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