Provider Demographics
NPI:1427361906
Name:LAGRUA, JESSICA ELIZABETH (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:LAGRUA
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 1:8 SHERIDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2322
Mailing Address - Country:US
Mailing Address - Phone:631-208-6556
Mailing Address - Fax:
Practice Address - Street 1:8 SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2322
Practice Address - Country:US
Practice Address - Phone:631-208-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10301751164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse