Provider Demographics
NPI:1801288857
Name:KAIN, JULISSA JASMINE (LPN)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:JASMINE
Last Name:KAIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JULISSA
Other - Middle Name:JASMINE
Other - Last Name:KAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:94 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1808
Mailing Address - Country:US
Mailing Address - Phone:607-481-5450
Mailing Address - Fax:607-737-7788
Practice Address - Street 1:94 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1808
Practice Address - Country:US
Practice Address - Phone:607-481-5450
Practice Address - Fax:607-737-7788
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316575164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse