Provider Demographics
NPI:1902169097
Name:PREVOST VALENTIN, GERALDINE (LPN)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:PREVOST VALENTIN
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 1:545 PINEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4313
Mailing Address - Country:US
Mailing Address - Phone:516-216-1138
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2707
Practice Address - Country:US
Practice Address - Phone:631-608-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309427164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse