Provider Demographics
NPI:1023389004
Name:PIERRE LOUIS, ISLANDE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ISLANDE
Middle Name:
Last Name:PIERRE LOUIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MAXINE
Other - Middle Name:
Other - Last Name:ANYWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:67 KIME AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3314
Mailing Address - Country:US
Mailing Address - Phone:631-456-7036
Mailing Address - Fax:631-242-2804
Practice Address - Street 1:67 KIME AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3314
Practice Address - Country:US
Practice Address - Phone:631-456-7036
Practice Address - Fax:631-242-2804
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233021-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01467885Medicaid