Provider Demographics
NPI:1871747915
Name:JIMBES, LORRETHA O
Entity type:Individual
Prefix:MS
First Name:LORRETHA
Middle Name:O
Last Name:JIMBES
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 1:4054 CARPENTER AVE
Mailing Address - Street 2:APT 4B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3680
Mailing Address - Country:US
Mailing Address - Phone:646-842-8004
Mailing Address - Fax:
Practice Address - Street 1:4054 CARPENTER AVE
Practice Address - Street 2:APT 4B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3680
Practice Address - Country:US
Practice Address - Phone:646-842-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY603364-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse