Provider Demographics
NPI:1457683476
Name:BURRISON, JANESSA YUVETTE (LPN)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:YUVETTE
Last Name:BURRISON
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 1:8847 208TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2258
Mailing Address - Country:US
Mailing Address - Phone:646-773-6705
Mailing Address - Fax:
Practice Address - Street 1:8847 208TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2258
Practice Address - Country:US
Practice Address - Phone:646-773-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3002031164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse