Provider Demographics
NPI:1972742765
Name:EARL, JOAN ROSEMARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ROSEMARIE
Last Name:EARL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ROSEMARIE
Other - Last Name:EARL-WHITAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 THEALL ROAD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580
Mailing Address - Country:US
Mailing Address - Phone:914-925-8255
Mailing Address - Fax:
Practice Address - Street 1:101 THEALL ROAD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580
Practice Address - Country:US
Practice Address - Phone:914-925-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29500-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse