Provider Demographics
NPI:1669125035
Name:IKEALUGO-DENNIS, JENNIFER C
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:IKEALUGO-DENNIS
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 1:3705 OLINVILLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5685
Mailing Address - Country:US
Mailing Address - Phone:347-994-5713
Mailing Address - Fax:
Practice Address - Street 1:3705 OLINVILLE AVE APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5685
Practice Address - Country:US
Practice Address - Phone:347-994-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse