Provider Demographics
NPI:1811870066
Name:DEMESA, QUEENIE SURIO (RN)
Entity type:Individual
Prefix:
First Name:QUEENIE
Middle Name:SURIO
Last Name:DEMESA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 HAZELTON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-1195
Mailing Address - Country:US
Mailing Address - Phone:707-803-1120
Mailing Address - Fax:
Practice Address - Street 1:7517 HAZELTON WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1195
Practice Address - Country:US
Practice Address - Phone:707-803-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse