Provider Demographics
NPI:1366629255
Name:DRAKE, JANICE DELOISE (LPN LICENSED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:DELOISE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPN LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MIDVALE TERR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619
Mailing Address - Country:US
Mailing Address - Phone:585-529-4178
Mailing Address - Fax:
Practice Address - Street 1:48 MIDVALE TERR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619
Practice Address - Country:US
Practice Address - Phone:585-529-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2268611164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse