Provider Demographics
NPI:1912107558
Name:DESIR, JEANNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:
Last Name:DESIR
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 1:161 FALLON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3609
Mailing Address - Country:US
Mailing Address - Phone:516-352-0293
Mailing Address - Fax:
Practice Address - Street 1:161 FALLON AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3609
Practice Address - Country:US
Practice Address - Phone:516-352-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY468063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse