Provider Demographics
NPI:1477025245
Name:VIXAMAR, JOAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:VIXAMAR
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 1:50 CHELSEA CT APT 16
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3927
Mailing Address - Country:US
Mailing Address - Phone:631-245-9322
Mailing Address - Fax:
Practice Address - Street 1:50 CHELSEA CT APT 16
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3927
Practice Address - Country:US
Practice Address - Phone:631-245-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296894-13747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty