MEDICARE: MS. JOANETTE AGATHA JANNIERE

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	212933	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568615326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANETTE AGATHA JANNIERE

Provider Business Mailing Address
First Line	:	124 PATTERSON AVE
Second Line	:
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-6537
Country	:	US
Telephone Number	:	347-256-6453
Fax Number	:

Provider Business Practice Location Address
First Line	:	11571 226TH ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1426
Country	:	US
Telephone Number	:	347-256-6453
Fax Number	:

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

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	02/18/2009

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