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NPI Code Detail

MEDICARE: MS. EVELYN ELAINE HAUGHTON FNP

MEDICARE: MS. EVELYN ELAINE HAUGHTON FNP
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
1363LF0000XFamily Nurse Practitioner335171-1NY

General Provider Information

NPI Number : 1578880597
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EVELYN ELAINE HAUGHTON FNP
Provider Business Mailing Address
First Line : 6735 112TH ST
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-2349
Country : US
Telephone Number : 718-263-0740
Fax Number : 718-263-9834
Provider Business Practice Location Address
First Line : 6735 112TH ST
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-2349
Country : US
Telephone Number : 718-263-0740
Fax Number : 718-263-9834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2010
Last Update Date : 04/29/2010

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