Provider Demographics
NPI:1598040792
Name:ALESE, YETUNDE
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:
Last Name:ALESE
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 1:321 BEACH 57TH ST
Mailing Address - Street 2:APT 6K
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1644
Mailing Address - Country:US
Mailing Address - Phone:646-821-5367
Mailing Address - Fax:
Practice Address - Street 1:321 BEACH 57TH ST
Practice Address - Street 2:APT 6K
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1644
Practice Address - Country:US
Practice Address - Phone:646-821-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294739164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse