Provider Demographics
NPI:1033520267
Name:JEANOUTE, DIEULIRA PHILIPPE (LPN)
Entity type:Individual
Prefix:
First Name:DIEULIRA
Middle Name:PHILIPPE
Last Name:JEANOUTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N MAIN ST APT 17A
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4113
Mailing Address - Country:US
Mailing Address - Phone:845-494-5942
Mailing Address - Fax:845-290-1468
Practice Address - Street 1:175 N MAIN ST APT 17A
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4113
Practice Address - Country:US
Practice Address - Phone:845-494-5942
Practice Address - Fax:845-290-1468
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314946164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse