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EDJEANINE BOUCICAULT LPN
NPI 1912624115
Licensed Practical Nurse in Lake Ronkonkoma, NY

Active since October 27, 2022
153 LAKE SHORE RD, LAKE RONKONKOMA, NY 11779(631) 522-6876 Get Directions Write a Review

NPPES record last updated: October 27, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Edjeanine Boucicault Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDJEANINE BOUCICAULT LPN (NPI 1912624115) is an individual licensed practical nurse in Lake Ronkonkoma, New York, licensed in New York (332414-1) and active in the NPI registry since October 2022.

NPPES Registry Identity

NPI1912624115
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameEDJEANINE BOUCICAULTCredential: LPN
Location Address153 LAKE SHORE RDLake Ronkonkoma, NY 11779-3193
Mailing Address153 Lake Shore RdLake Ronkonkoma, NY 11779-3193 · (631) 522-6876
Phone(631) 522-6876
Sole ProprietorYes
Enumeration DateOctober 27, 2022
NPPES CertifiedOctober 27, 2022
✔ NPI 1912624115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in NY · 332414-1
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
153 LAKE SHORE RD, Lake Ronkonkoma, NY 11779
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Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REGGIE DONALD VALDEMAR PHMNP
Nurse Practitioner (Psychiatric/Mental Health)
153 LAKE SHORE RD
RONKONKOMA, NY 11779
Suffolk County (111) 111-1111
MS. MICHELE ANN KELLY CPNP NPP
Nurse Practitioner
153 LAKE SHORE RD, PHOENIX HOUSE MEDICAL DEPT
RONKONKOMA, NY 11779
Suffolk County (631) 471-5666
ALTAGRACE GILBERT BLANCHARD
Licensed Practical Nurse
153 LAKE SHORE RD
LAKE RONKONKOMA, NY 11779
Suffolk County (844) 815-1508
NICHOLAS MARTIN PASCULLO LPN
Licensed Practical Nurse
153 LAKE SHORE RD
LAKE RONKONKOMA, NY 11779
Suffolk County (631) 471-5666
MRS. MELISSA PAZ RN
Registered Nurse
153 LAKE SHORE RD
LAKE RONKONKOMA, NY 11779
Suffolk County (718) 233-4376
LYDIE CHERY REGISTERED NURSE
Registered Nurse
153 LAKE SHORE RD
LAKE RONKONKOMA, NY 11779
Suffolk County (631) 925-7619
JUSTIN MICHAEL TAYLOR I LICENSED MSW
Social Worker
153 LAKE SHORE RD
LAKE RONKONKOMA, NY 11779
Suffolk County (631) 471-5666

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edjeanine Boucicault's NPI number?

The NPI number for Edjeanine Boucicault is 1912624115. It was assigned to this individual provider in the NPPES registry on October 27, 2022.

Where is Edjeanine Boucicault located?

Edjeanine Boucicault practices at 153 Lake Shore Rd, Lake Ronkonkoma, NY 11779. The listed phone number is (631) 522-6876.

What is Edjeanine Boucicault's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Edjeanine Boucicault was last updated on October 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.