Provider Demographics
NPI:1194362061
Name:DIEUDONNE, VANESSA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DIEUDONNE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2792 ROUTE 6 APT 2
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-3813
Mailing Address - Country:US
Mailing Address - Phone:845-421-5717
Mailing Address - Fax:
Practice Address - Street 1:2792 ROUTE 6 APT 2
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-3813
Practice Address - Country:US
Practice Address - Phone:845-421-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY807763163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse