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General NPI Number Information
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NPI Number | 1437041670
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Entity Type | Individual
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Provider Name | FERNANDO LUIS DE JESUS JR. RN
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Gender | Male
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 145 PINE HAVEN SHORES SUITE 1000A
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City | SHELBURNE
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State | VT
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Zip | 05482
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Country | US
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Telephone | 802-204-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 145 PINE HAVEN SHORES SUITE 100A
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City | SHELBURNE
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State | VT
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Zip | 05482
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Country | US
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Telephone | 802-204-0044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 026.0154884PROV
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 026.0154884PROV
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 026.0154884PROV
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 026.0154884PROV
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License Number State | VT
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