Provider Demographics
NPI:1245567999
Name:THERMIDOR, YANICK (LPN)
Entity Type:Individual
Prefix:MS
First Name:YANICK
Middle Name:
Last Name:THERMIDOR
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 1:54 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1321
Mailing Address - Country:US
Mailing Address - Phone:631-592-1076
Mailing Address - Fax:
Practice Address - Street 1:54 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1321
Practice Address - Country:US
Practice Address - Phone:631-592-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297134-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse