Provider Demographics
NPI:1356816615
Name:VAZQUEZ, XENA ALEXANDRA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:XENA
Middle Name:ALEXANDRA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2118
Mailing Address - Country:US
Mailing Address - Phone:516-398-4126
Mailing Address - Fax:
Practice Address - Street 1:941 MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2118
Practice Address - Country:US
Practice Address - Phone:516-398-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY756012163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health