| Doctor Name: | RAQUEL DEJESUS |
| NPI Number: | 1689923054 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, NP-C |
| License Number: | 71004072A |
| Business Practice Address: | 4421 International Ct Apt 13 Berrien Springs, MI - 49103 |
| Business Phone Number: | 2033943745 |
| Business Fax Number: | |
| Mailing Address: | 4421 International Ct, Apt 13 BERRIEN SPRINGS |
| State: | MI |
| Postal Code: | 49103 |
| Phone Number: | 2033943745 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2012 |
| NPI Last Update Date: | 08/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71004072A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |