Provider Demographics
NPI:1568712552
Name:YUNIQUE DESIRE-BRISARD FNP LNC
Entity Type:Organization
Organization Name:YUNIQUE DESIRE-BRISARD FNP LNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YUNIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIRE-BRISARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-648-1160
Mailing Address - Street 1:1339 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4046
Practice Address - Country:US
Practice Address - Phone:646-648-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty