Provider Demographics
NPI:1659690972
Name:DE JESUS, DOLORITA (ANP)
Entity Type:Individual
Prefix:
First Name:DOLORITA
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLAZA NORTH
Mailing Address - Street 2:SUITE 428
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-2066
Mailing Address - Fax:516-663-4655
Practice Address - Street 1:222 STATION PLAZA NORTH
Practice Address - Street 2:SUITE 428
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-2066
Practice Address - Fax:516-663-4655
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301496363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care