Provider Demographics
NPI:1548699770
Name:JIMENEZ, LIDIA (LPN)
Entity type:Individual
Prefix:MS
First Name:LIDIA
Middle Name:
Last Name:JIMENEZ
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ROSENHAYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08352-0130
Mailing Address - Country:US
Mailing Address - Phone:856-451-3410
Mailing Address - Fax:856-451-5053
Practice Address - Street 1:536 ELM STREET
Practice Address - Street 2:
Practice Address - City:ROSENHAYN
Practice Address - State:NJ
Practice Address - Zip Code:08352
Practice Address - Country:US
Practice Address - Phone:856-451-3410
Practice Address - Fax:856-451-5053
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NPO5264400372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion