Provider Demographics
NPI:1619569191
Name:ANNAND, JENNIFER (LPN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ANNAND
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:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-0072
Mailing Address - Country:US
Mailing Address - Phone:516-810-1054
Mailing Address - Fax:
Practice Address - Street 1:32 S BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1737
Practice Address - Country:US
Practice Address - Phone:516-810-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324745-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse