Provider Demographics
NPI:1760887632
Name:TREADWELL, IRENE (LPN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:TREADWELL
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 1:4106 12TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6317
Mailing Address - Country:US
Mailing Address - Phone:347-886-9660
Mailing Address - Fax:
Practice Address - Street 1:4106 12TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-6317
Practice Address - Country:US
Practice Address - Phone:347-886-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307611164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse