Provider Demographics
NPI:1821448747
Name:PETION, JOSSELINE
Entity Type:Individual
Prefix:
First Name:JOSSELINE
Middle Name:
Last Name:PETION
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 1:130 VANDALIA AVE
Mailing Address - Street 2:APT 11E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1420
Mailing Address - Country:US
Mailing Address - Phone:347-831-7018
Mailing Address - Fax:
Practice Address - Street 1:130 VANDALIA AVE
Practice Address - Street 2:APT 11E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1420
Practice Address - Country:US
Practice Address - Phone:347-831-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse