Provider Demographics
NPI:1487906228
Name:ENGSTROM, JEAN E (REGISTERED PROF NUR)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:E
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:REGISTERED PROF NUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 ST. THERESA AVE
Mailing Address - Street 2:APT #3D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4144
Mailing Address - Country:US
Mailing Address - Phone:914-290-9920
Mailing Address - Fax:718-589-8061
Practice Address - Street 1:2916 ST. THERESA AVE
Practice Address - Street 2:APT #3D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4144
Practice Address - Country:US
Practice Address - Phone:914-290-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313987163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool