Healthcare Provider Details

I. General information

NPI: 1649164286
Provider Name (Legal Business Name): DEANA MARIE MARCUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANA MARIE JESTER-MITCHELL RN

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

2940 E 194TH ST APT 1
BRONX NY
10461-3986
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4411
  • Fax:
Mailing address:
  • Phone: 918-924-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number710119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: