Provider Demographics
NPI:1255693206
Name:CAREW, JUAN ANITA
Entity Type:Individual
Prefix:MRS
First Name:JUAN
Middle Name:ANITA
Last Name:CAREW
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUAN
Other - Middle Name:ANITA
Other - Last Name:CORLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12238 134TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3015
Mailing Address - Country:US
Mailing Address - Phone:718-291-7545
Mailing Address - Fax:
Practice Address - Street 1:13 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6003
Practice Address - Country:US
Practice Address - Phone:516-823-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649470163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY649470OtherRN LICENSE