MEDICARE: LUNELLE JEANITH

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	163W00000X	Registered Nurse	617545	NY

General Provider Information

NPI Number	:	1932426178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUNELLE JEANITH

Provider Business Mailing Address
First Line	:	1339 E 83RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5101
Country	:	US
Telephone Number	:	347-636-1072
Fax Number	:	347-636-1072

Provider Business Practice Location Address
First Line	:	1339 E 83RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5101
Country	:	US
Telephone Number	:	347-636-1072
Fax Number	:	347-636-1072

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	10/02/2013

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Directions to “ LUNELLE JEANITH ” Practice Location

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