Provider Demographics
NPI:1609694876
Name:NORWOOD, JALISE JOANNA (LPN)
Entity type:Individual
Prefix:
First Name:JALISE
Middle Name:JOANNA
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORDWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1620
Mailing Address - Country:US
Mailing Address - Phone:719-308-4323
Mailing Address - Fax:
Practice Address - Street 1:10 CORDWOOD PATH
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1620
Practice Address - Country:US
Practice Address - Phone:719-308-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351521164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse