Provider Demographics
NPI:1790095396
Name:KING, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 GATES AVE
Mailing Address - Street 2:APT 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:347-404-7257
Mailing Address - Fax:
Practice Address - Street 1:435 GATES AVE
Practice Address - Street 2:APT 3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:347-404-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487283163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool