Provider Demographics
NPI:1023375086
Name:DENNIS, IMOGENE PAULETTE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:IMOGENE
Middle Name:PAULETTE
Last Name:DENNIS
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 1:801 TILDEN ST
Mailing Address - Street 2:#23H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6026
Mailing Address - Country:US
Mailing Address - Phone:347-346-5851
Mailing Address - Fax:
Practice Address - Street 1:801 TILDEN ST
Practice Address - Street 2:#23H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6026
Practice Address - Country:US
Practice Address - Phone:347-346-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308901-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse