Provider Demographics
NPI:1174810857
Name:DEIESO, ALEXIS MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MARIE
Last Name:DEIESO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PIKE PL
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1932
Mailing Address - Country:US
Mailing Address - Phone:914-582-1584
Mailing Address - Fax:
Practice Address - Street 1:83 NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1527
Practice Address - Country:US
Practice Address - Phone:914-522-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse