Provider Demographics
NPI:1386209385
Name:DESIR WEEKES, MARIE ANGE
Entity Type:Individual
Prefix:
First Name:MARIE ANGE
Middle Name:
Last Name:DESIR WEEKES
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 1:635 DIELLEN LN
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4517
Mailing Address - Country:US
Mailing Address - Phone:321-276-1100
Mailing Address - Fax:
Practice Address - Street 1:635 DIELLEN LN
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4517
Practice Address - Country:US
Practice Address - Phone:321-276-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4971451163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health