Provider Demographics
NPI:1164753521
Name:DIEUJUSTE, MARIE ALOURDES
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ALOURDES
Last Name:DIEUJUSTE
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 1:11 FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7701
Mailing Address - Country:US
Mailing Address - Phone:631-767-9065
Mailing Address - Fax:
Practice Address - Street 1:11 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7701
Practice Address - Country:US
Practice Address - Phone:631-767-8809
Practice Address - Fax:631-952-2373
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse