MEDICARE: JUDETTE DIEUDONNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	413878	NY

General Provider Information

NPI Number	:	1831609114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDETTE DIEUDONNE

Provider Business Mailing Address
First Line	:	1431 E 88TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 E 88TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5119
Country	:	US
Telephone Number	:	718-763-3741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	03/17/2018

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Directions to “ JUDETTE DIEUDONNE ” Practice Location

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