Provider Demographics
NPI:1184959892
Name:MEHALA, JEANNETTE PATRICIA (RN)
Entity type:Individual
Prefix:MISS
First Name:JEANNETTE
Middle Name:PATRICIA
Last Name:MEHALA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120-56 228ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411
Mailing Address - Country:US
Mailing Address - Phone:718-712-7795
Mailing Address - Fax:718-712-6986
Practice Address - Street 1:120-56 228ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411
Practice Address - Country:US
Practice Address - Phone:718-712-7795
Practice Address - Fax:718-712-6986
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse