Provider Demographics
NPI:1396998936
Name:VAN SLUYTMAN, DESIREE ANGELA (LPN)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ANGELA
Last Name:VAN SLUYTMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CLEVELAND STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:518-823-0739
Mailing Address - Fax:516-823-1550
Practice Address - Street 1:13 CLEVELAND STREET
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:518-823-0739
Practice Address - Fax:516-823-1550
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265456164W00000X
NY636659163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY265456OtherUNIVERSITY OF THE STATE OF NEW YORK
NY265456OtherLPN LICENSE NUMBER