Provider Demographics
NPI:1265188015
Name:JUMEAU, MIRELLE (RN,BSN,CVRN,BC)
Entity type:Individual
Prefix:
First Name:MIRELLE
Middle Name:
Last Name:JUMEAU
Suffix:
Gender:F
Credentials:RN,BSN,CVRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 HEMPSTEAD TPKE STE C
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1602
Mailing Address - Country:US
Mailing Address - Phone:516-395-1073
Mailing Address - Fax:
Practice Address - Street 1:479 HEMPSTEAD TPKE STE C
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1602
Practice Address - Country:US
Practice Address - Phone:516-395-1073
Practice Address - Fax:516-544-6621
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6613301163WH0200X, 376G00000X
NY661330-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty