Basic Information
| Provider Information | |||||||||
| NPI: | 1114275187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OCTAVIEN | ||||||||
| FirstName: | LUCIEN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | OCTAVIEN | ||||||||
| OtherFirstName: | FRANCOISE | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 75 1ER ANE BOLOSSE | ||||||||
| Address2: | |||||||||
| City: | PORT-AU-PRINCE | ||||||||
| State: | CAPITAL | ||||||||
| PostalCode: | WI | ||||||||
| CountryCode: | HT | ||||||||
| TelephoneNumber: | 5091035339 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 255 WARNER AVE | ||||||||
| Address2: | |||||||||
| City: | ROSLYN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115771000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166215400 | ||||||||
| FaxNumber: | 5166214879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2012 | ||||||||
| LastUpdateDate: | 08/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 31055-1 | NY | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.