Provider Demographics
NPI:1346586575
Name:HEMINGWAY, THERISA GIOVANA (LPN)
Entity Type:Individual
Prefix:MS
First Name:THERISA
Middle Name:GIOVANA
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:THERISA
Other - Middle Name:GIOVANA
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:20 WENDELL ST
Mailing Address - Street 2:APT 29B
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1206
Mailing Address - Country:US
Mailing Address - Phone:516-492-2993
Mailing Address - Fax:
Practice Address - Street 1:20 WENDELL ST
Practice Address - Street 2:APT 29B
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1206
Practice Address - Country:US
Practice Address - Phone:516-492-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094011164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse