Provider Demographics
NPI:1568615326
Name:JANNIERE, JOANETTE AGATHA
Entity Type:Individual
Prefix:MS
First Name:JOANETTE
Middle Name:AGATHA
Last Name:JANNIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6537
Mailing Address - Country:US
Mailing Address - Phone:347-256-6453
Mailing Address - Fax:
Practice Address - Street 1:11571 226TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1426
Practice Address - Country:US
Practice Address - Phone:347-256-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212933164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010556898Medicaid