Provider Demographics
NPI:1730749409
Name:BRUTUS, JEANNET (RN)
Entity type:Individual
Prefix:
First Name:JEANNET
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HAWTHORNE AVE APT 55
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-5101
Mailing Address - Country:US
Mailing Address - Phone:631-336-6884
Mailing Address - Fax:
Practice Address - Street 1:199 HAWTHORNE AVE APT 55
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-5101
Practice Address - Country:US
Practice Address - Phone:631-336-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY748478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse