Provider Demographics
NPI:1114160595
Name:DUARTE, JOANNA MAGDALENA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MAGDALENA
Last Name:DUARTE
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 1:30 THIRD ST.
Mailing Address - Street 2:PO 192
Mailing Address - City:HILLBURN
Mailing Address - State:NY
Mailing Address - Zip Code:10931-0192
Mailing Address - Country:US
Mailing Address - Phone:845-652-0864
Mailing Address - Fax:
Practice Address - Street 1:30 THIRD STREET
Practice Address - Street 2:
Practice Address - City:HILLBURN
Practice Address - State:NY
Practice Address - Zip Code:10931-0192
Practice Address - Country:US
Practice Address - Phone:845-652-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281541-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse