Healthcare Provider Details

I. General information

NPI: 1255107918
Provider Name (Legal Business Name): VERENA THELISMA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

111 E 86TH ST
BROOKLYN NY
11236-1250
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3000
  • Fax:
Mailing address:
  • Phone: 914-272-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number870097-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: