Healthcare Provider Details

I. General information

NPI: 1487906228
Provider Name (Legal Business Name): JEAN E ENGSTROM REGISTERED PROF. NUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 ST. THERESA AVE APT #3D
BRONX NY
10461-4144
US

IV. Provider business mailing address

2916 ST. THERESA AVE APT #3D
BRONX NY
10461-4144
US

V. Phone/Fax

Practice location:
  • Phone: 914-290-9920
  • Fax:
Mailing address:
  • Phone: 914-290-9920
  • Fax: 718-589-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number313987
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: