Provider Demographics
NPI:1093258097
Name:OLIVERT, THERCY SAINT JEAN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:THERCY
Middle Name:SAINT JEAN
Last Name:OLIVERT
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 1:9832 57TH AVE APT 11O
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4931
Mailing Address - Country:US
Mailing Address - Phone:516-450-1807
Mailing Address - Fax:
Practice Address - Street 1:9832 57TH AVE APT 11O
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4931
Practice Address - Country:US
Practice Address - Phone:516-450-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327209164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse