Provider Demographics
NPI:1154641462
Name:DALRYMPLE, DESIREE SIMONE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:SIMONE
Last Name:DALRYMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:SIMONE
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1871 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-5000
Mailing Address - Country:US
Mailing Address - Phone:917-224-4110
Mailing Address - Fax:
Practice Address - Street 1:1871 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933-5000
Practice Address - Country:US
Practice Address - Phone:917-224-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282443164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse