Provider Demographics
NPI:1902098718
Name:HARRY, DESIREE ULALIE (RN)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:ULALIE
Last Name:HARRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:GLEN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:339 MARTENSE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4201
Mailing Address - Country:US
Mailing Address - Phone:718-284-7265
Mailing Address - Fax:
Practice Address - Street 1:339 MARTENSE ST
Practice Address - Street 2:1ST FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4201
Practice Address - Country:US
Practice Address - Phone:718-284-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420207163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02287429Medicaid