Provider Demographics
NPI:1780316968
Name:FERNANDES, LETITIA (RN)
Entity type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:
Last Name:FERNANDES
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 1:297 MONTGOMERY ST APT 1W
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4033
Mailing Address - Country:US
Mailing Address - Phone:551-208-0686
Mailing Address - Fax:
Practice Address - Street 1:297 MONTGOMERY ST APT 1W
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4033
Practice Address - Country:US
Practice Address - Phone:551-208-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13902500163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty