Provider Demographics
NPI:1851552863
Name:FEQUIERE, JOVITE (NA)
Entity Type:Individual
Prefix:MRS
First Name:JOVITE
Middle Name:
Last Name:FEQUIERE
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2704
Mailing Address - Country:US
Mailing Address - Phone:631-920-2652
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1749
Practice Address - Country:US
Practice Address - Phone:631-361-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341947800303E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide