Provider Demographics
NPI:1033419064
Name:SURPRIS, DARLINE
Entity Type:Individual
Prefix:
First Name:DARLINE
Middle Name:
Last Name:SURPRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E 94TH ST
Mailing Address - Street 2:#2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1105
Mailing Address - Country:US
Mailing Address - Phone:347-579-5834
Mailing Address - Fax:
Practice Address - Street 1:655 EAST 94 STREET
Practice Address - Street 2:#2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2104
Practice Address - Country:US
Practice Address - Phone:347-579-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627839163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool