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NPI Code Detail

MEDICARE: JAZMIN NECOLE ROBERTS LPN

MEDICARE: JAZMIN NECOLE ROBERTS 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
1164W00000XLicensed Practical Nurse314061NY

General Provider Information

NPI Number : 1760025225
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMIN NECOLE ROBERTS LPN
Provider Business Mailing Address
First Line : 19 SWAN ST FL 1
Second Line :
City : GREEN ISLAND
State : NY
Zip : 12183-1401
Country : US
Telephone Number : 518-443-9159
Fax Number :
Provider Business Practice Location Address
First Line : 52 CORPORATE CIR
Second Line :
City : ALBANY
State : NY
Zip : 12203-5176
Country : US
Telephone Number : 518-456-4466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2019
Last Update Date : 10/28/2019

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Directions to “ JAZMIN NECOLE ROBERTS LPN” Practice Location

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