Provider Demographics
NPI:1992120679
Name:FOREMAN, JEQUEENA DENESE (CNA)
Entity type:Individual
Prefix:MS
First Name:JEQUEENA
Middle Name:DENESE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VERNON ST. #200
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-901-8670
Mailing Address - Fax:203-891-7854
Practice Address - Street 1:17 VERNON ST # 200
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1342
Practice Address - Country:US
Practice Address - Phone:203-901-8670
Practice Address - Fax:203-891-7854
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT372500000X372500000X
CT376K00000X372600000X, 376K00000X
CT372600000X372600000X
CT3747A0650X3747A0650X
CT3747P1801X3747P1801X
CT374U00000X374U00000X
CT376J00000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide