Provider Demographics
NPI:1518683689
Name:DESMORNESNESBITT, CHRISTELLE FREDA
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:FREDA
Last Name:DESMORNESNESBITT
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 1:10 N NEWARK ST
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9709
Mailing Address - Country:US
Mailing Address - Phone:718-970-0011
Mailing Address - Fax:
Practice Address - Street 1:10 N NEWARK ST
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-9709
Practice Address - Country:US
Practice Address - Phone:718-970-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34414401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse