Provider Demographics
NPI:1518304039
Name:MITRAS, JOANNE GLORIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:GLORIA
Last Name:MITRAS
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 1:227 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12522-5515
Mailing Address - Country:US
Mailing Address - Phone:845-877-6917
Mailing Address - Fax:845-373-8916
Practice Address - Street 1:227 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522-5515
Practice Address - Country:US
Practice Address - Phone:845-877-6917
Practice Address - Fax:845-373-8916
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291706164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse