Provider Demographics
NPI:1407198682
Name:CARRASCO, ERIBERT AMELIA (LPN)
Entity type:Individual
Prefix:MISS
First Name:ERIBERT
Middle Name:AMELIA
Last Name:CARRASCO
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 1:120 W 94TH ST
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7026
Mailing Address - Country:US
Mailing Address - Phone:212-470-5978
Mailing Address - Fax:
Practice Address - Street 1:120 W 94TH ST
Practice Address - Street 2:APT. 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7026
Practice Address - Country:US
Practice Address - Phone:212-470-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305476-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse