Provider Demographics
NPI:1366777963
Name:IANNUCCI, JANICE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:IANNUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:71 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2942
Mailing Address - Country:US
Mailing Address - Phone:516-938-0020
Mailing Address - Fax:516-470-1475
Practice Address - Street 1:71 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2942
Practice Address - Country:US
Practice Address - Phone:516-938-0020
Practice Address - Fax:516-470-1475
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304305363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health