Provider Demographics
NPI:1497195820
Name:JEAN-JACQUES, MARIE CARMELITE (RN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CARMELITE
Last Name:JEAN-JACQUES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 DURYEA AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2221
Mailing Address - Country:US
Mailing Address - Phone:516-417-6670
Mailing Address - Fax:
Practice Address - Street 1:454 DURYEA AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2221
Practice Address - Country:US
Practice Address - Phone:516-417-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4681431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse