Provider Demographics
NPI:1073140133
Name:CHEVANNES, KRISTINE ALYSSA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINE
Middle Name:ALYSSA
Last Name:CHEVANNES
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 1:210 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2133
Mailing Address - Country:US
Mailing Address - Phone:631-413-4257
Mailing Address - Fax:
Practice Address - Street 1:2 OHIO DR STE 101
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1111
Practice Address - Country:US
Practice Address - Phone:516-622-6000
Practice Address - Fax:516-622-6111
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse