Provider Demographics
NPI:1346525664
Name:JABBAAR, CAMILLE MONIQUE (LPN)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MONIQUE
Last Name:JABBAAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:MONIQUE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6000 GIRARD AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2158
Mailing Address - Country:US
Mailing Address - Phone:910-366-7312
Mailing Address - Fax:
Practice Address - Street 1:6000 GIRARD AVE APT 2D
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2158
Practice Address - Country:US
Practice Address - Phone:910-366-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276526164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse