Provider Demographics
NPI:1871017269
Name:METAYER, ISLANDIE (LPN)
Entity type:Individual
Prefix:MS
First Name:ISLANDIE
Middle Name:
Last Name:METAYER
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 1:5797 ITHACA CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6752
Mailing Address - Country:US
Mailing Address - Phone:561-577-6153
Mailing Address - Fax:
Practice Address - Street 1:5797 ITHACA CIR E
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6752
Practice Address - Country:US
Practice Address - Phone:561-577-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5226511164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2321000000XMedicaid