Provider Demographics
NPI:1659690444
Name:MCBEAN-CICERO, HYACINTH LORETTE (LPN)
Entity Type:Individual
Prefix:
First Name:HYACINTH
Middle Name:LORETTE
Last Name:MCBEAN-CICERO
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 1:14022 247TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2132
Mailing Address - Country:US
Mailing Address - Phone:718-527-5020
Mailing Address - Fax:
Practice Address - Street 1:14022 247TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2132
Practice Address - Country:US
Practice Address - Phone:718-527-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299847164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY299847OtherLPN LICENSE