Healthcare Provider Details

I. General information

NPI: 1457662306
Provider Name (Legal Business Name): SUN OK MUN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BEDFORD PARK BLVD APT 4B
BRONX NY
10458-2546
US

IV. Provider business mailing address

222 E 204TH ST APT 1F
BRONX NY
10458-1326
US

V. Phone/Fax

Practice location:
  • Phone: 917-474-7474
  • Fax:
Mailing address:
  • Phone: 917-474-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337888
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number5962351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: