Provider Demographics
NPI:1740628031
Name:DEJESUS, JOSEPH JOSEPH (RN)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOSEPH
Last Name:DEJESUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 BOCA LAGO DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4420
Mailing Address - Country:US
Mailing Address - Phone:219-669-8964
Mailing Address - Fax:
Practice Address - Street 1:1402 BOCA LAGO DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4420
Practice Address - Country:US
Practice Address - Phone:219-669-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041329061372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider