Provider Demographics
NPI:1386985323
Name:DEMOSTHENE, ROSE MARIE (RN)
Entity type:Individual
Prefix:
First Name:ROSE MARIE
Middle Name:
Last Name:DEMOSTHENE
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 1:100 NORTH PORTLAND AVENUE
Mailing Address - Street 2:CUMBERLAND D&TC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205
Mailing Address - Country:US
Mailing Address - Phone:718-260-7500
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:CUMBERLAND D&TC
Practice Address - Street 2:100 NORTH PORTLAND AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-260-7500
Practice Address - Fax:718-630-3122
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7046013163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care