Provider Demographics
NPI:1508315722
Name:ROBLES, KATHERINE J (LPN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:ROBLES
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 1:3421 77TH ST
Mailing Address - Street 2:APT. 510
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2338
Mailing Address - Country:US
Mailing Address - Phone:917-583-2102
Mailing Address - Fax:
Practice Address - Street 1:3421 77TH ST
Practice Address - Street 2:APT. 510
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2338
Practice Address - Country:US
Practice Address - Phone:917-583-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326811164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse