Provider Demographics
NPI:1821400425
Name:GARRANGE, JESSICA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:GARRANGE
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 1:124 ALLERS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2202
Mailing Address - Country:US
Mailing Address - Phone:516-771-2176
Mailing Address - Fax:
Practice Address - Street 1:124 ALLERS BLVD
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-2202
Practice Address - Country:US
Practice Address - Phone:516-771-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317801-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse