Provider Demographics
NPI:1659657955
Name:TAVERAS, ROSARIO IVELISSE (LPN)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:IVELISSE
Last Name:TAVERAS
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 1:105 HAVEN AVE
Mailing Address - Street 2:3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 HAVEN AVE
Practice Address - Street 2:3F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2705
Practice Address - Country:US
Practice Address - Phone:347-465-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse