Provider Demographics
NPI:1255734745
Name:DENESTANT, JUNIDE
Entity type:Individual
Prefix:
First Name:JUNIDE
Middle Name:
Last Name:DENESTANT
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 1:460 JEFFERSON AVE
Mailing Address - Street 2:APT C
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1153
Mailing Address - Country:US
Mailing Address - Phone:908-425-3999
Mailing Address - Fax:
Practice Address - Street 1:460 JEFFERSON AVE
Practice Address - Street 2:APT C
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-1153
Practice Address - Country:US
Practice Address - Phone:908-425-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse