Provider Demographics
NPI:1417129008
Name:DIEUDONNE, THERESE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:DIEUDONNE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2037
Mailing Address - Country:US
Mailing Address - Phone:631-943-4257
Mailing Address - Fax:
Practice Address - Street 1:241 FULTON ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2037
Practice Address - Country:US
Practice Address - Phone:631-491-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580277-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse