Provider Demographics
NPI:1285332916
Name:DERISSE, MARIE-LOURDES (RN)
Entity type:Individual
Prefix:
First Name:MARIE-LOURDES
Middle Name:
Last Name:DERISSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 BOSTON POST RD
Mailing Address - Street 2:175
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477
Mailing Address - Country:US
Mailing Address - Phone:203-815-9279
Mailing Address - Fax:
Practice Address - Street 1:554 BOSTON POST RD # 175
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3341
Practice Address - Country:US
Practice Address - Phone:203-815-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY479264163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management