Provider Demographics
NPI:1083042337
Name:PAULINO, JEANETTE
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:PAULINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPRING ST
Mailing Address - Street 2:3K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4136
Mailing Address - Country:US
Mailing Address - Phone:917-941-7073
Mailing Address - Fax:
Practice Address - Street 1:21 SPRING ST
Practice Address - Street 2:3K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4136
Practice Address - Country:US
Practice Address - Phone:917-941-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312203-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse