Provider Demographics
NPI:1427396134
Name:BARRETT, STEPHANIE (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BARRETT
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 1:140 BRADHURST AVE
Mailing Address - Street 2:4H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2402
Mailing Address - Country:US
Mailing Address - Phone:347-664-3967
Mailing Address - Fax:
Practice Address - Street 1:140 BRADHURST AVE
Practice Address - Street 2:4H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-2402
Practice Address - Country:US
Practice Address - Phone:347-664-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2599041164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse