Provider Demographics
NPI:1497901706
Name:LEBEAU, JENNELL ROSE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JENNELL
Middle Name:ROSE
Last Name:LEBEAU
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 1:46 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2307
Mailing Address - Country:US
Mailing Address - Phone:716-578-3870
Mailing Address - Fax:
Practice Address - Street 1:46 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2307
Practice Address - Country:US
Practice Address - Phone:716-578-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289434164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse