Provider Demographics
NPI:1225600372
Name:DESSALINES, MARIE MICHEL
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MICHEL
Last Name:DESSALINES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:MICHEL
Other - Last Name:DESSALINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DESSALINES
Mailing Address - Street 1:8, LAMLIGHT VILLAGE ROAD
Mailing Address - Street 2:APT B
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950
Mailing Address - Country:US
Mailing Address - Phone:914-741-4516
Mailing Address - Fax:
Practice Address - Street 1:1075 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2346
Practice Address - Country:US
Practice Address - Phone:914-741-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726593163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse