Provider Demographics
NPI:1457683070
Name:REDDOCK, VIOLET VERITA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:VIOLET
Middle Name:VERITA
Last Name:REDDOCK
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 1:680 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5222
Mailing Address - Country:US
Mailing Address - Phone:718-629-9374
Mailing Address - Fax:
Practice Address - Street 1:680 E 46TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5222
Practice Address - Country:US
Practice Address - Phone:718-629-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250224164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse