Provider Demographics
NPI:1619257920
Name:JEMISON, LA SHAWN RENEE (RN)
Entity Type:Individual
Prefix:
First Name:LA SHAWN
Middle Name:RENEE
Last Name:JEMISON
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 1:115 CRARY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1405
Mailing Address - Country:US
Mailing Address - Phone:914-656-0538
Mailing Address - Fax:
Practice Address - Street 1:115 CRARY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1405
Practice Address - Country:US
Practice Address - Phone:914-656-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY497710163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse