Provider Demographics
NPI:1740768977
Name:THEMISTOCLE, LESNIDE (RN)
Entity Type:Individual
Prefix:
First Name:LESNIDE
Middle Name:
Last Name:THEMISTOCLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESNIDE
Other - Middle Name:
Other - Last Name:THEMISTOCLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:74 LAW ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1018
Mailing Address - Country:US
Mailing Address - Phone:516-469-7825
Mailing Address - Fax:
Practice Address - Street 1:74 LAW ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1018
Practice Address - Country:US
Practice Address - Phone:516-285-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY511484163W00000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163W00000XNursing Service ProvidersRegistered Nurse