Provider Demographics
NPI:1508063231
Name:STEPHENS, GERALDINE ROSAMOND (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:ROSAMOND
Last Name:STEPHENS
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 1:756 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3283
Mailing Address - Country:US
Mailing Address - Phone:718-964-0875
Mailing Address - Fax:
Practice Address - Street 1:592 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5539
Practice Address - Country:US
Practice Address - Phone:718-345-5000
Practice Address - Fax:718-346-6747
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268720164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse