Provider Demographics
NPI:1699005520
Name:RODRIGUEZ, JENNIFER (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:RODRIGUEZ
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 1:90 HEILMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3016
Mailing Address - Country:US
Mailing Address - Phone:631-566-0900
Mailing Address - Fax:
Practice Address - Street 1:90 HEILMAN AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3016
Practice Address - Country:US
Practice Address - Phone:631-566-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-25
Last Update Date:2009-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299837-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse