Provider Demographics
NPI:1154819753
Name:DE JESUS, NOEMI (RN)
Entity Type:Individual
Prefix:MRS
First Name:NOEMI
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NOEMI
Other - Middle Name:
Other - Last Name:APONTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1 KATAVOLOS DR
Mailing Address - Street 2:
Mailing Address - City:TOMKINS COVE
Mailing Address - State:NY
Mailing Address - Zip Code:10986-1417
Mailing Address - Country:US
Mailing Address - Phone:845-942-8491
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4917
Practice Address - Country:US
Practice Address - Phone:845-499-5496
Practice Address - Fax:845-290-1435
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily