Provider Demographics
NPI:1306411640
Name:CHRISTMAS, JEVON (LPN)
Entity Type:Individual
Prefix:
First Name:JEVON
Middle Name:
Last Name:CHRISTMAS
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 1:43 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8114
Mailing Address - Country:US
Mailing Address - Phone:908-258-8765
Mailing Address - Fax:
Practice Address - Street 1:43 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8114
Practice Address - Country:US
Practice Address - Phone:908-258-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05882300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse