Provider Demographics
NPI:1649780842
Name:JEAN-ROMAIN, ANDRELLE
Entity type:Individual
Prefix:
First Name:ANDRELLE
Middle Name:
Last Name:JEAN-ROMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 EAST 19TH ST, APT #3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4810
Mailing Address - Country:US
Mailing Address - Phone:646-689-9581
Mailing Address - Fax:
Practice Address - Street 1:165 E 19TH ST APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4810
Practice Address - Country:US
Practice Address - Phone:646-689-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496448-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse