Provider Demographics
NPI:1407148208
Name:DERREL, YELITZA
Entity Type:Individual
Prefix:
First Name:YELITZA
Middle Name:
Last Name:DERREL
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 1:3 MADISON LN
Mailing Address - Street 2:APT. 2I
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1070
Mailing Address - Country:US
Mailing Address - Phone:516-633-4283
Mailing Address - Fax:
Practice Address - Street 1:3 MADISON LN
Practice Address - Street 2:APT. 2I
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1070
Practice Address - Country:US
Practice Address - Phone:516-633-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse