Provider Demographics
NPI:1457541476
Name:PURCELL, JANELL (LPN)
Entity Type:Individual
Prefix:MS
First Name:JANELL
Middle Name:
Last Name:PURCELL
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 1:100 RANDALL AVE
Mailing Address - Street 2:APT#4A
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2751
Mailing Address - Country:US
Mailing Address - Phone:516-967-1428
Mailing Address - Fax:516-665-3333
Practice Address - Street 1:13614 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1934
Practice Address - Country:US
Practice Address - Phone:718-523-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2613031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02287965Medicaid