Provider Demographics
NPI:1154680759
Name:JEAN, JOVIA
Entity Type:Individual
Prefix:MISS
First Name:JOVIA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JOVIA
Other - Middle Name:J
Other - Last Name:GENEUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:234 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6055
Mailing Address - Country:US
Mailing Address - Phone:845-821-1138
Mailing Address - Fax:866-436-6702
Practice Address - Street 1:234 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-6055
Practice Address - Country:US
Practice Address - Phone:845-821-1138
Practice Address - Fax:866-436-6702
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297799-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse