Individual
MAILIQUE JAQUETTE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
200 N LEVITT ST APT 423, ROME, NY 13440-3083
(315) 334-2630
Mailing address
200 N LEVITT ST APT 423, ROME, NY 13440-3083
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
276331
NY
Other
Enumeration date
07/06/2015
Last updated
07/06/2015
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