Provider Demographics
NPI:1295984524
Name:JEAN-JACQUES, MINERVE
Entity type:Individual
Prefix:
First Name:MINERVE
Middle Name:
Last Name:JEAN-JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4144
Mailing Address - Country:US
Mailing Address - Phone:718-612-2765
Mailing Address - Fax:
Practice Address - Street 1:13601 BENNETT ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4144
Practice Address - Country:US
Practice Address - Phone:718-612-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse