Individual
ANDRISE DESORMEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
742 HOME ST, ELMONT, NY 11003-4612
(516) 792-6728
Mailing address
742 HOME ST, ELMONT, NY 11003-4612
(516) 792-6728
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
317501
NY
Other
Enumeration date
07/10/2014
Last updated
07/10/2014
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