Provider Demographics
NPI:1831440320
Name:DE JESUS, NERISSA (NP)
Entity type:Individual
Prefix:
First Name:NERISSA
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N STATE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1468
Mailing Address - Country:US
Mailing Address - Phone:914-762-5810
Mailing Address - Fax:914-762-4223
Practice Address - Street 1:465 N STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1468
Practice Address - Country:US
Practice Address - Phone:914-762-5810
Practice Address - Fax:914-762-4223
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430678363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care