Provider Demographics
NPI:1710513379
Name:DE LAS NUECES, MELISSA (RN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:DE LAS NUECES
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 1:920 TRINITY AVE APT 17H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-7425
Mailing Address - Country:US
Mailing Address - Phone:646-648-0106
Mailing Address - Fax:
Practice Address - Street 1:22215 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3678
Practice Address - Country:US
Practice Address - Phone:516-900-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY788748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse