Healthcare Provider Details

I. General information

NPI: 1992030373
Provider Name (Legal Business Name): MIRIAM O EMOKPAE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

17316 LINDEN BLVD
JAMAICA NY
11434-1331
US

V. Phone/Fax

Practice location:
  • Phone: 917-834-3187
  • Fax:
Mailing address:
  • Phone: 917-834-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number618992
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: