Provider Demographics
NPI:1932422813
Name:JERANEK, NOREEN E (LPN)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:E
Last Name:JERANEK
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 1:1806 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2147
Mailing Address - Country:US
Mailing Address - Phone:516-809-6627
Mailing Address - Fax:516-809-6627
Practice Address - Street 1:1806 MONROE AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2147
Practice Address - Country:US
Practice Address - Phone:516-809-6627
Practice Address - Fax:516-809-6627
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300444164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse