Healthcare Provider Details

I. General information

NPI: 1245544832
Provider Name (Legal Business Name): LOVETH EFOSA ABU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVENUE 4TH FLOOR
BRONX NY
10457-7606
US

IV. Provider business mailing address

1276 FULTON AVENUE 4TH FLOOR
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 917-361-7510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336189
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF336189-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: