Provider Demographics
NPI:1639363617
Name:DE JESUS, NELLY (RNBSN)
Entity Type:Individual
Prefix:MS
First Name:NELLY
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE GUAYAMA
Mailing Address - Street 2:EDIFICIO A APT.#702
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4601
Mailing Address - Country:US
Mailing Address - Phone:787-753-5255
Mailing Address - Fax:
Practice Address - Street 1:CALLE GUAYAMA
Practice Address - Street 2:EDIFICIO A APT.#702
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-4601
Practice Address - Country:US
Practice Address - Phone:787-753-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1165163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation