Provider Demographics
NPI:1548633993
Name:STRANGE, JAHNICE MONIQUE (LPN)
Entity type:Individual
Prefix:MS
First Name:JAHNICE
Middle Name:MONIQUE
Last Name:STRANGE
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 1:226 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4154
Mailing Address - Country:US
Mailing Address - Phone:631-394-4920
Mailing Address - Fax:
Practice Address - Street 1:226 CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4154
Practice Address - Country:US
Practice Address - Phone:631-394-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205875-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse