Provider Demographics
NPI:1225260045
Name:D'HAITI DESPINOS, MARJORY (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MRS
First Name:MARJORY
Middle Name:
Last Name:D'HAITI DESPINOS
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1604
Mailing Address - Country:US
Mailing Address - Phone:201-503-0991
Mailing Address - Fax:
Practice Address - Street 1:132 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1604
Practice Address - Country:US
Practice Address - Phone:201-503-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305241363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health