Provider Demographics
NPI:1972955581
Name:PROVOST, FAITH ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:ANN
Last Name:PROVOST
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 1:7053 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-2954
Mailing Address - Country:US
Mailing Address - Phone:845-665-5152
Mailing Address - Fax:
Practice Address - Street 1:7053 ROUTE 209
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446-2954
Practice Address - Country:US
Practice Address - Phone:845-665-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304197164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse