Provider Demographics
NPI:1528606704
Name:ACEVEDO, JENNY GLORIA (LPN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:GLORIA
Last Name:ACEVEDO
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 1:9 HILLSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1724
Mailing Address - Country:US
Mailing Address - Phone:516-410-5224
Mailing Address - Fax:
Practice Address - Street 1:9 HILLSBORO AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1724
Practice Address - Country:US
Practice Address - Phone:516-410-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337396164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse