Provider Demographics
NPI:1811422587
Name:KONAN, NGUESSAN PELAGIE (LPN)
Entity Type:Individual
Prefix:
First Name:NGUESSAN
Middle Name:PELAGIE
Last Name:KONAN
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 1:240 LEXINGTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1235
Mailing Address - Country:US
Mailing Address - Phone:201-598-0642
Mailing Address - Fax:
Practice Address - Street 1:240 LEXINGTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1235
Practice Address - Country:US
Practice Address - Phone:201-598-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328398164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse