Provider Demographics
NPI:1366714537
Name:DEEGBE, JOLENE E (RN)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:E
Last Name:DEEGBE
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 1:1175 ANDERSON AVENUE
Mailing Address - Street 2:2EE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452
Mailing Address - Country:US
Mailing Address - Phone:646-463-8601
Mailing Address - Fax:
Practice Address - Street 1:1175 ANDERSON AVE
Practice Address - Street 2:2EE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3805
Practice Address - Country:US
Practice Address - Phone:646-463-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY601768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse