Provider Demographics
NPI:1124402557
Name:RAMIREZ, IVELISSE M
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:M
Last Name:RAMIREZ
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 1:759 EAGLE AVE
Mailing Address - Street 2:3C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-7890
Mailing Address - Country:US
Mailing Address - Phone:224-623-3915
Mailing Address - Fax:
Practice Address - Street 1:759 EAGLE AVE
Practice Address - Street 2:3C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:224-623-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258293164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse