Provider Demographics
NPI:1104977677
Name:MOWERS, JOYCELYN A (LPN)
Entity type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:A
Last Name:MOWERS
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 1:432 ANN ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-6604
Mailing Address - Country:US
Mailing Address - Phone:315-339-6451
Mailing Address - Fax:
Practice Address - Street 1:348 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2129
Practice Address - Country:US
Practice Address - Phone:315-363-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10206369164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02121108Medicaid