Provider Demographics
NPI:1831375963
Name:FRAIN, JESSICA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:FRAIN
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 1:325 N END AVE
Mailing Address - Street 2:9H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1026
Mailing Address - Country:US
Mailing Address - Phone:631-617-3809
Mailing Address - Fax:
Practice Address - Street 1:325 N END AVE
Practice Address - Street 2:9H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282-1026
Practice Address - Country:US
Practice Address - Phone:631-617-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264274-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02186038Medicare PIN