Healthcare Provider Details

I. General information

NPI: 1932429578
Provider Name (Legal Business Name): TAMEIKA L WELLINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMEIKA L GRANT REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ALCOTT PL APT 6E
BRONX NY
10475-4229
US

IV. Provider business mailing address

120 ALCOTT PL APT 6E
BRONX NY
10475-4229
US

V. Phone/Fax

Practice location:
  • Phone: 347-257-5346
  • Fax:
Mailing address:
  • Phone: 347-257-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number647997
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: