Individual
KETHLINE JEAN DACISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 FRONT ST, HEMPSTEAD, NY 11550-4600
(516) 705-9700
Mailing address
11 WHALEY ST, FREEPORT, NY 11520-4920
(516) 643-7752
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
481694
NY
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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