MEDICARE: DILNOZA T ERKABOYEVA R.N

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	723062	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	723062	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1801345368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DILNOZA T ERKABOYEVA R.N

Provider Business Mailing Address
First Line	:	8704 15TH AVE
Second Line	:	2F
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3715
Country	:	US
Telephone Number	:	917-484-3467
Fax Number	:

Provider Business Practice Location Address
First Line	:	8704 15TH AVE
Second Line	:	2F
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3715
Country	:	US
Telephone Number	:	917-484-3467
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	09/26/2016

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