Provider Demographics
NPI:1619290723
Name:GARBUTT, PAULETTE MAUREEN (LPN)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:MAUREEN
Last Name:GARBUTT
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 1:1001 JEROME AVE
Mailing Address - Street 2:APT 10E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-5704
Mailing Address - Country:US
Mailing Address - Phone:718-588-6491
Mailing Address - Fax:
Practice Address - Street 1:1001 JEROME AVE
Practice Address - Street 2:APT 10E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5704
Practice Address - Country:US
Practice Address - Phone:718-588-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238203164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY238203OtherLPN LICENSE