Provider Demographics
NPI:1710264387
Name:JEUDY-PIERRE, LOVELY (RN)
Entity Type:Individual
Prefix:MRS
First Name:LOVELY
Middle Name:
Last Name:JEUDY-PIERRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LOVELY
Other - Middle Name:PASKA
Other - Last Name:JEUDY-PIERRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:97-32 221 STREET
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429
Mailing Address - Country:US
Mailing Address - Phone:718-217-5052
Mailing Address - Fax:888-503-1825
Practice Address - Street 1:21247 JAMAICA AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1607
Practice Address - Country:US
Practice Address - Phone:718-454-2038
Practice Address - Fax:888-503-1828
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695295-1163W00000X
NY6952959-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)