Healthcare Provider Details

I. General information

NPI: 1639363617
Provider Name (Legal Business Name): NELLY DE JESUS RNBSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE GUAYAMA EDIFICIO A APT.#702
HATO REY PR
00917-4601
US

IV. Provider business mailing address

CALLE GUAYAMA EDIFICIO A APT.#702
HATO REY PR
00917-4601
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-5255
  • Fax:
Mailing address:
  • Phone: 787-753-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number1165
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: