Provider Demographics
NPI:1649050535
Name:JEAN-MICHEL, CLYTENDRE (LPN)
Entity type:Individual
Prefix:
First Name:CLYTENDRE
Middle Name:
Last Name:JEAN-MICHEL
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 1:49 THEODORE ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4090
Mailing Address - Country:US
Mailing Address - Phone:617-943-5173
Mailing Address - Fax:
Practice Address - Street 1:49 THEODORE ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4090
Practice Address - Country:US
Practice Address - Phone:617-943-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN101447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse