Healthcare Provider Details

I. General information

NPI: 1912771494
Provider Name (Legal Business Name): ISATOU YAINENEH DUKURAY MSN,APRN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 SAINT RAYMOND AVE APT 7A
BRONX NY
10462-7123
US

IV. Provider business mailing address

2125 SAINT RAYMOND AVE APT 7A
BRONX NY
10462-7123
US

V. Phone/Fax

Practice location:
  • Phone: 646-420-9624
  • Fax:
Mailing address:
  • Phone: 646-420-9624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number746573-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352192-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: