Provider Demographics
NPI:1669983953
Name:DESROULEAUX, CARINE (RN)
Entity type:Individual
Prefix:
First Name:CARINE
Middle Name:
Last Name:DESROULEAUX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11836 NASHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1920
Mailing Address - Country:US
Mailing Address - Phone:718-776-2422
Mailing Address - Fax:
Practice Address - Street 1:11836 NASHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1920
Practice Address - Country:US
Practice Address - Phone:917-335-3458
Practice Address - Fax:917-335-3458
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635279-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse