Provider Demographics
NPI:1013389428
Name:METELLUS, OSALENNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:OSALENNE
Middle Name:
Last Name:METELLUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:APT. 6 G
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1916
Mailing Address - Country:US
Mailing Address - Phone:347-297-9279
Mailing Address - Fax:
Practice Address - Street 1:23214 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2115
Practice Address - Country:US
Practice Address - Phone:347-297-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321848-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse