Provider Demographics
NPI:1841630027
Name:DU BOUSQUET, JEAN PHILIPPE MICHAEL (LPN)
Entity type:Individual
Prefix:MR
First Name:JEAN PHILIPPE
Middle Name:MICHAEL
Last Name:DU BOUSQUET
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18514 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3211
Mailing Address - Country:US
Mailing Address - Phone:516-647-3592
Mailing Address - Fax:
Practice Address - Street 1:18514 144TH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3211
Practice Address - Country:US
Practice Address - Phone:516-647-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313395-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse