Provider Demographics
NPI:1952605214
Name:MORT-TROISE, JEANETTE (RN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MORT-TROISE
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 1:1902 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4605
Mailing Address - Country:US
Mailing Address - Phone:302-655-7109
Mailing Address - Fax:302-655-0689
Practice Address - Street 1:1902 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4605
Practice Address - Country:US
Practice Address - Phone:302-655-7109
Practice Address - Fax:302-655-0689
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0010413163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse