Healthcare Provider Details

I. General information

NPI: 1346563624
Provider Name (Legal Business Name): HERMENEGILDE MARY NALUYIMA SR. NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 AQUINAS ST
BINGHAMTON NY
13905-3947
US

IV. Provider business mailing address

4 AQUINAS ST
BINGHAMTON NY
13905-3947
US

V. Phone/Fax

Practice location:
  • Phone: 920-517-7806
  • Fax:
Mailing address:
  • Phone: 920-517-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberF305334-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0305334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: