Provider Demographics
NPI:1053662916
Name:ULYSSE, NOEMIE
Entity Type:Individual
Prefix:
First Name:NOEMIE
Middle Name:
Last Name:ULYSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOEMIE
Other - Middle Name:
Other - Last Name:FAUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:57 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2333
Mailing Address - Country:US
Mailing Address - Phone:631-920-0370
Mailing Address - Fax:
Practice Address - Street 1:57 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2333
Practice Address - Country:US
Practice Address - Phone:631-920-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7345950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse