Basic Information
| Provider Information | |||||||||
| NPI: | 1134782832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESRIVIERES | ||||||||
| FirstName: | NADEGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9343 212TH PL | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114281602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475563429 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3636 33RD ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111062329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182240262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 318672 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.