Provider Demographics
NPI:1497111538
Name:DESSOURCES, YOLETTE
Entity Type:Individual
Prefix:
First Name:YOLETTE
Middle Name:
Last Name:DESSOURCES
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 1:96 MEMPHIS AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3534
Mailing Address - Country:US
Mailing Address - Phone:516-499-1172
Mailing Address - Fax:
Practice Address - Street 1:96 MEMPHIS AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3534
Practice Address - Country:US
Practice Address - Phone:516-499-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203702164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse