Provider Demographics
NPI:1679856728
Name:CURTIS, JERMAIN GERALD (LPN)
Entity Type:Individual
Prefix:
First Name:JERMAIN
Middle Name:GERALD
Last Name:CURTIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:JERMAIN
Other - Middle Name:GERALD
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:20 OLD TURNPIKE RD
Mailing Address - Street 2:STE 307
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2532
Mailing Address - Country:US
Mailing Address - Phone:845-624-0260
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD
Practice Address - Street 2:STE 307
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY307003OtherLICENSED PRACTICAL NURSE
NY750322OtherREGISTERED NURSE