Madeline Avila

Individual provider Active NPI Licensed Practical Nurse · Roosevelt, NY

NPI 1295869451 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1295869451
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
278804-01 (NY)
Practice address
380 Washington Ave
Roosevelt, NY 11575-1845
Phone
(516) 378-2000
NPI assigned
Mar 16, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
278804-01NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 278804-01 NY Yes

Addresses

Primary practice location

380 Washington Ave
Roosevelt, NY 11575-1845

Mailing address

380 Washington Ave
Roosevelt, NY 11575-1845
Phone (516) 378-2000

Other providers in Roosevelt, NY

All providers in Roosevelt, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.