Provider Demographics
NPI:1114144789
Name:PIERRE-JACQUES, MARIE ENELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ENELLE
Last Name:PIERRE-JACQUES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORFOLK DR W
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4814
Mailing Address - Country:US
Mailing Address - Phone:551-628-5874
Mailing Address - Fax:516-285-8741
Practice Address - Street 1:30 NORFOLK DR W
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4814
Practice Address - Country:US
Practice Address - Phone:551-628-5874
Practice Address - Fax:516-285-8741
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205523-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse