Healthcare Provider Details

I. General information

NPI: 1902303274
Provider Name (Legal Business Name): MARIA JASANYA CNM, RNC, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SPENCER ST APT 4A
BROOKLYN NY
11205-4774
US

IV. Provider business mailing address

175 SPENCER ST APT 4A
BROOKLYN NY
11205-4774
US

V. Phone/Fax

Practice location:
  • Phone: 347-210-3365
  • Fax:
Mailing address:
  • Phone: 347-210-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number104382733
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001660
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number593360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: