Provider Demographics
NPI:1154022150
Name:JEAN-LOUIS, CYNTHIA (LPN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:JEAN-LOUIS
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 1:34 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2825
Mailing Address - Country:US
Mailing Address - Phone:631-809-9367
Mailing Address - Fax:
Practice Address - Street 1:34 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2825
Practice Address - Country:US
Practice Address - Phone:631-809-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339834-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse