Provider Demographics
NPI:1033659206
Name:RHATIGAN, JARRED (LPN)
Entity Type:Individual
Prefix:MR
First Name:JARRED
Middle Name:
Last Name:RHATIGAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PECONIC ST APT 291B
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7163
Mailing Address - Country:US
Mailing Address - Phone:646-714-8481
Mailing Address - Fax:
Practice Address - Street 1:500 PECONIC ST APT 291B
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7163
Practice Address - Country:US
Practice Address - Phone:646-714-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318722-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health