Healthcare Provider Details

I. General information

NPI: 1801291596
Provider Name (Legal Business Name): MRS. ROUDELINE PETION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ROUDELINE ETIENNE

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST
BROOKLYN NY
11201-4405
US

IV. Provider business mailing address

44 COURT ST
BROOKLYN NY
11201-4405
US

V. Phone/Fax

Practice location:
  • Phone: 718-222-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number665994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: