Provider Demographics
NPI:1861274326
Name:JEAN, LEOPOLDINE LYNN (RN)
Entity type:Individual
Prefix:
First Name:LEOPOLDINE
Middle Name:LYNN
Last Name:JEAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEOPOLDINE
Other - Middle Name:LYNN
Other - Last Name:ST ELOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 KIRKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3704
Mailing Address - Country:US
Mailing Address - Phone:516-424-0757
Mailing Address - Fax:
Practice Address - Street 1:390 KIRKMAN AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3704
Practice Address - Country:US
Practice Address - Phone:151-642-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY909077163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse