Provider Demographics
NPI:1053651216
Name:JURKOWSKI, ROSE (LPN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:JURKOWSKI
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 1:7343 TRENTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304
Mailing Address - Country:US
Mailing Address - Phone:315-896-4232
Mailing Address - Fax:
Practice Address - Street 1:7343 TRENTON RD
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-1844
Practice Address - Country:US
Practice Address - Phone:315-896-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195205-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY164W00000XMedicaid