Provider Demographics
NPI:1164925822
Name:THERMITUS, YVROSE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:YVROSE
Middle Name:
Last Name:THERMITUS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:YVROSE
Other - Middle Name:
Other - Last Name:THERMITUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:642 CARLYLE PL
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9020
Mailing Address - Country:US
Mailing Address - Phone:201-618-3706
Mailing Address - Fax:973-313-2506
Practice Address - Street 1:642 CARLYLE PL
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9020
Practice Address - Country:US
Practice Address - Phone:201-618-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12319900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NO12319900OtherLICENSE NUMBER
NJ26NO12319900OtherRN LICENSE NUMBER