Provider Demographics
NPI:1467727438
Name:DE JESUS, MARIA I (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:I
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 WASHINGTON AVE
Mailing Address - Street 2:P. S. 159 MEDICAL ROOM
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-7754
Mailing Address - Country:US
Mailing Address - Phone:718-933-7381
Mailing Address - Fax:718-933-7381
Practice Address - Street 1:2315 WASHINGTON AVE
Practice Address - Street 2:P. S. 159 MEDICAL ROOM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-7754
Practice Address - Country:US
Practice Address - Phone:718-933-7381
Practice Address - Fax:718-933-7381
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse