Provider Demographics
NPI:1558561159
Name:BRETT, KARYN JENNIFER (RN)
Entity Type:Individual
Prefix:MRS
First Name:KARYN
Middle Name:JENNIFER
Last Name:BRETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WINDING PATH
Mailing Address - Street 2:APT 09
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2263
Mailing Address - Country:US
Mailing Address - Phone:631-704-4269
Mailing Address - Fax:
Practice Address - Street 1:28 WINDING PATH
Practice Address - Street 2:APT 09
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2263
Practice Address - Country:US
Practice Address - Phone:631-704-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565546-1163W00000X, 163WX0200X
NY565546163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02534036Medicaid