Provider Demographics
NPI:1043587371
Name:JEAN, MAGUENITE
Entity type:Individual
Prefix:
First Name:MAGUENITE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 E 56TH ST
Mailing Address - Street 2:APT 5C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4022
Mailing Address - Country:US
Mailing Address - Phone:917-600-9311
Mailing Address - Fax:
Practice Address - Street 1:853 EMPIRE BLVD
Practice Address - Street 2:APT 5C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5766
Practice Address - Country:US
Practice Address - Phone:917-600-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306265-1164W00000X
NY680215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse