Provider Demographics
NPI:1912348004
Name:LABELLE, DENISE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:LABELLE
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 1:11 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2823
Mailing Address - Country:US
Mailing Address - Phone:631-567-5464
Mailing Address - Fax:
Practice Address - Street 1:11 PALMER DR
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2823
Practice Address - Country:US
Practice Address - Phone:631-567-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305165-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY305165-1Medicaid