Provider Demographics
NPI:1932929619
Name:HENRIQUES, DORNELL MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:DORNELL
Middle Name:MICHAEL
Last Name:HENRIQUES
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 1:3420 EDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2609
Mailing Address - Country:US
Mailing Address - Phone:718-502-7772
Mailing Address - Fax:
Practice Address - Street 1:3420 EDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2609
Practice Address - Country:US
Practice Address - Phone:718-502-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse