Provider Demographics
NPI:1366172454
Name:PAGAN, JOLENE (RN)
Entity type:Individual
Prefix:MISS
First Name:JOLENE
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:14319 84TH RD
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2227
Mailing Address - Country:US
Mailing Address - Phone:718-913-1460
Mailing Address - Fax:
Practice Address - Street 1:14319 84TH RD
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2227
Practice Address - Country:US
Practice Address - Phone:718-913-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY810243163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool