MEDICARE: MS. CHINYE N UZOR RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	22 581405	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22 581405	OTHER	NY	RN

General Provider Information

NPI Number	:	1104114032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHINYE N UZOR RN

Provider Business Mailing Address
First Line	:	165 ITHACA ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-4606
Country	:	US
Telephone Number	:	817-455-9057
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 ITHACA ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-4606
Country	:	US
Telephone Number	:	817-455-9057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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