Provider Demographics
NPI:1548007610
Name:PARENTE, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:PARENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CEDAR GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2970
Mailing Address - Country:US
Mailing Address - Phone:631-449-5921
Mailing Address - Fax:
Practice Address - Street 1:34 CEDAR GROVE AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2970
Practice Address - Country:US
Practice Address - Phone:631-449-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307535164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse