Provider Demographics
NPI:1861909897
Name:IRIZARRY, MAYRA JEANNETTE (LPN)
Entity type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:JEANNETTE
Last Name:IRIZARRY
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 1:190 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1502
Mailing Address - Country:US
Mailing Address - Phone:212-677-3400
Mailing Address - Fax:
Practice Address - Street 1:190 MERCER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1502
Practice Address - Country:US
Practice Address - Phone:212-677-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316824164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse