Provider Demographics
NPI:1407179385
Name:ST JEAN, CARLINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARLINE
Middle Name:
Last Name:ST JEAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:C
Other - Last Name:ST.JEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3201 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4115
Mailing Address - Country:US
Mailing Address - Phone:917-860-9536
Mailing Address - Fax:
Practice Address - Street 1:3201 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4115
Practice Address - Country:US
Practice Address - Phone:917-860-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300098-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse