Provider Demographics
NPI:1134645500
Name:HUNTER, JEFFREY JEROME (LPN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JEROME
Last Name:HUNTER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PINEWOODS CRES
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1572
Mailing Address - Country:US
Mailing Address - Phone:631-742-5168
Mailing Address - Fax:
Practice Address - Street 1:47 PINEWOODS CRES
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1572
Practice Address - Country:US
Practice Address - Phone:631-742-5168
Practice Address - Fax:631-742-5168
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312873-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse