Provider Demographics
NPI:1588060107
Name:EMMANUEL, KEVIN (LPN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:EMMANUEL
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 1:148 ELM ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3935
Mailing Address - Country:US
Mailing Address - Phone:646-441-0340
Mailing Address - Fax:
Practice Address - Street 1:148 ELM ST APT 4E
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3935
Practice Address - Country:US
Practice Address - Phone:646-441-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse