Provider Demographics
NPI:1487190765
Name:JIMINIAN, DENISE MERCEDES (LPN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MERCEDES
Last Name:JIMINIAN
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 1:777 WESTCHESTER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3520
Mailing Address - Country:US
Mailing Address - Phone:914-997-0420
Mailing Address - Fax:
Practice Address - Street 1:777 WESTCHESTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3520
Practice Address - Country:US
Practice Address - Phone:914-997-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312018164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse