Provider Demographics
NPI:1629343454
Name:VASCONI, JEAN ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ELLEN
Last Name:VASCONI
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 1:105 HAMILTON AVE
Mailing Address - Street 2:MEDICAL ROOM
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1610
Mailing Address - Country:US
Mailing Address - Phone:718-390-1800
Mailing Address - Fax:718-273-8240
Practice Address - Street 1:105 HAMILTON AVE
Practice Address - Street 2:MEDICAL ROOM
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1610
Practice Address - Country:US
Practice Address - Phone:718-390-1800
Practice Address - Fax:718-273-8240
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234344-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool