Provider Demographics
NPI:1710263645
Name:ST JEAN, KATIA (LPN)
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:ST JEAN
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 1:2143 GLEASON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4708
Mailing Address - Country:US
Mailing Address - Phone:917-721-7319
Mailing Address - Fax:
Practice Address - Street 1:2143 GLEASON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4708
Practice Address - Country:US
Practice Address - Phone:917-721-7319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287710164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse