Provider Demographics
NPI:1427715952
Name:JEAN, MARVIN CHRISTOPHER (LPN)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:CHRISTOPHER
Last Name:JEAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 STATE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1319
Mailing Address - Country:US
Mailing Address - Phone:518-380-4766
Mailing Address - Fax:
Practice Address - Street 1:714 STATE ST FL 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1319
Practice Address - Country:US
Practice Address - Phone:518-380-4766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339833163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice