Provider Demographics
NPI:1396185393
Name:DE JESUS, EMMA P (RNMSNRADM)
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:P
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:RNMSNRADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2384
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4384
Mailing Address - Country:US
Mailing Address - Phone:787-205-5834
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA TROPICAL 25 CALLE CARIBE
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-4384
Practice Address - Country:US
Practice Address - Phone:787-205-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1811163WA2000X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator