MEDICARE: MISS HELENA MANTEBEA ADU 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	616013-1	NY

General Provider Information

NPI Number	:	1720367386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HELENA MANTEBEA ADU RN

Provider Business Mailing Address
First Line	:	1706 UNDERCLIFF AVE
Second Line	:	PH
City	:	BRONX
State	:	NY
Zip	:	10453-6742
Country	:	US
Telephone Number	:	718-295-4681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 UNDERCLIFF AVE
Second Line	:	PH
City	:	BRONX
State	:	NY
Zip	:	10453-6742
Country	:	US
Telephone Number	:	718-295-4681
Fax Number	:

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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