Provider Demographics
NPI:1548908585
Name:DE JESUS, VIVIAN E
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:E
Last Name:DE JESUS
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 1:189 ORCHARD HILL LN
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-3405
Mailing Address - Country:US
Mailing Address - Phone:860-230-5795
Mailing Address - Fax:
Practice Address - Street 1:189 ORCHARD HILL LN
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-3405
Practice Address - Country:US
Practice Address - Phone:860-230-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker