Provider Demographics
NPI:1689126690
Name:MONDESTIN, ESTHER WADLINE (RN)
Entity Type:Individual
Prefix:MISS
First Name:ESTHER
Middle Name:WADLINE
Last Name:MONDESTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 LOTT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5085
Mailing Address - Country:US
Mailing Address - Phone:646-691-7161
Mailing Address - Fax:
Practice Address - Street 1:73 LOTT ST
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:646-691-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY562297-1164W00000X
NY562297364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No164W00000XNursing Service ProvidersLicensed Practical Nurse