Provider Demographics
NPI:1043453913
Name:MACENA, JOAEUSE
Entity Type:Individual
Prefix:
First Name:JOAEUSE
Middle Name:
Last Name:MACENA
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 1:219 COLIGNI AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2305
Mailing Address - Country:US
Mailing Address - Phone:914-813-0129
Mailing Address - Fax:
Practice Address - Street 1:219 COLIGNI AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2305
Practice Address - Country:US
Practice Address - Phone:914-813-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264730-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse