Provider Demographics
NPI:1720538143
Name:CESAIRE, ROSE EMELINE (FNP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:EMELINE
Last Name:CESAIRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:373 ROUTE 111, SUITE 14
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0249
Mailing Address - Country:US
Mailing Address - Phone:631-265-7577
Mailing Address - Fax:631-265-0204
Practice Address - Street 1:373 ROUTE 111 STE 14
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-265-7577
Practice Address - Fax:631-265-0204
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily