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General NPI Number Information
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NPI Number | 1962265132
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Entity Type | Individual
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Provider Name | JOHANE N/A DESRUISSEAUX NP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 81 JUNIUS ST
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City | BROOKLYN
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State | NY
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Zip | 11212-8004
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Country | US
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Telephone | 718-866-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 30 E 33RD ST
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City | NEW YORK
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State | NY
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Zip | 10016-5337
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Country | US
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Telephone | 212-366-4459
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F405123-01
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License Number State | NY
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