Healthcare Provider Details

I. General information

NPI: 1013623081
Provider Name (Legal Business Name): CATHERINE ENE IDOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 04/08/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 9TH ST
BROOKLYN NY
11215-4007
US

IV. Provider business mailing address

341 9TH ST
BROOKLYN NY
11215-4007
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-3414
  • Fax:
Mailing address:
  • Phone: 718-499-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: