Provider Demographics
NPI:1437041670
Name:DE JESUS, FERNANDO LUIS JR (RN)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:LUIS
Last Name:DE JESUS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:145 PINE HAVEN SHORES
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482
Mailing Address - Country:US
Mailing Address - Phone:802-204-0044
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES
Practice Address - Street 2:SUITE 1000A
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482
Practice Address - Country:US
Practice Address - Phone:802-204-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0154884PROV163WC1500X, 163WI0500X, 163WW0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care