Provider Demographics
NPI:1982007043
Name:JACQUES, MINERVE
Entity Type:Individual
Prefix:
First Name:MINERVE
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1008
Mailing Address - Country:US
Mailing Address - Phone:914-365-0914
Mailing Address - Fax:
Practice Address - Street 1:66 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1008
Practice Address - Country:US
Practice Address - Phone:914-365-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312503-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse