MEDICARE: MRS. JACQUELINE ZINSOU LPN/RN

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	250385	NY
2	163W00000X	Registered Nurse	627980	NY

General Provider Information

NPI Number	:	1972751071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE ZINSOU LPN/RN

Provider Business Mailing Address
First Line	:	2 ALEX CT
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2473
Country	:	US
Telephone Number	:	631-738-1017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 ALEX CT
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2473
Country	:	US
Telephone Number	:	631-738-1017
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	11/23/2010

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