Provider Demographics
NPI:1528345238
Name:JERIN, CORI LEE (LPN)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:LEE
Last Name:JERIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:LEE
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 POWERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-3544
Mailing Address - Country:US
Mailing Address - Phone:315-823-4388
Mailing Address - Fax:
Practice Address - Street 1:115 POWERHOUSE RD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-3544
Practice Address - Country:US
Practice Address - Phone:315-823-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232524-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse