Provider Demographics
NPI:1619414737
Name:MONDESIR, MARIE CLUNY (RN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CLUNY
Last Name:MONDESIR
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 1:33 FENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3205
Mailing Address - Country:US
Mailing Address - Phone:508-216-3791
Mailing Address - Fax:
Practice Address - Street 1:33 FENWAY CIR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3205
Practice Address - Country:US
Practice Address - Phone:508-216-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2271848163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse