Provider Demographics
NPI:1366816779
Name:MAUTE, JILLIAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:
Last Name:MAUTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 GERARD RD
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-9709
Mailing Address - Country:US
Mailing Address - Phone:631-655-3543
Mailing Address - Fax:
Practice Address - Street 1:86 GERARD RD
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-9709
Practice Address - Country:US
Practice Address - Phone:631-655-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse