Provider Demographics
NPI:1770852881
Name:JARVIS, LORAYNE MOLLY (RN)
Entity Type:Individual
Prefix:
First Name:LORAYNE
Middle Name:MOLLY
Last Name:JARVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SAWDUST AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-8442
Mailing Address - Country:US
Mailing Address - Phone:845-658-7130
Mailing Address - Fax:
Practice Address - Street 1:72 SAWDUST AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-8442
Practice Address - Country:US
Practice Address - Phone:845-658-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32540280OtherCMU