JETTAYA TIES'E DECOSTA

RIVERHEAD, NY
NPI1679815427
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy163W00000X Registered Nurse
(Licence: NY  768677)
Additional Taxonomies164W00000X Licensed Practical Nurse
(Licence: NY  313600-1)
Enumeration Date2013-03-20
Last Update Date2019-04-30
Business Address
Ms. JETTAYA TIES'E DECOSTA RN
124 OLD QUOGUE RD
RIVERHEAD, NY 11901-3941
Phone number: 631-494-8488
Mailing Address
Ms. JETTAYA TIES'E DECOSTA RN
PO BOX 1634
RIVERHEAD, NY 11901-0604
Phone number: 631-494-8488