Provider Demographics
NPI:1811757446
Name:PAGAN, JANE (LPN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:PAGAN
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 1:40 MATHES ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10537-1303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 MATHES ST
Practice Address - Street 2:
Practice Address - City:LAKE PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10537-1303
Practice Address - Country:US
Practice Address - Phone:914-584-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237276-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse