Provider Demographics
NPI:1699274746
Name:JACQUET, MARTHE JEHANE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARTHE
Middle Name:JEHANE
Last Name:JACQUET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARTHE
Other - Middle Name:JEHANE
Other - Last Name:MISERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3730
Mailing Address - Country:US
Mailing Address - Phone:917-583-6335
Mailing Address - Fax:
Practice Address - Street 1:7925 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2128
Practice Address - Country:US
Practice Address - Phone:718-464-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY669097-1163WP0809X
NY406343363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult