Provider Demographics
NPI:1972057164
Name:MAYA, JEAN (RN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MAYA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ROSEMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1426
Mailing Address - Country:US
Mailing Address - Phone:914-309-1918
Mailing Address - Fax:
Practice Address - Street 1:55 ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1426
Practice Address - Country:US
Practice Address - Phone:914-309-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331423163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics