MEDICARE: ELENA PEREIRA ACNP

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	440309	NY
2	363LA2100X	Acute Care Nurse Practitioner	F430318-1	NY

General Provider Information

NPI Number	:	1649585076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA PEREIRA ACNP

Provider Business Mailing Address
First Line	:	75-59 263 STREET
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1306
Country	:	US
Telephone Number	:	718-470-8306
Fax Number	:	718-470-4678

Provider Business Practice Location Address
First Line	:	75-59 263 STREET
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1306
Country	:	US
Telephone Number	:	718-470-8306
Fax Number	:	718-470-4678

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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