Healthcare Provider Details

I. General information

NPI: 1245830728
Provider Name (Legal Business Name): QUEENA YOLANDA HOANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 5TH AVE
BROOKLYN NY
11209-5932
US

IV. Provider business mailing address

126 SCHMIDTS LN
STATEN ISLAND NY
10314-5459
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-1701
  • Fax:
Mailing address:
  • Phone: 917-518-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: