Healthcare Provider Details

I. General information

NPI: 1851848709
Provider Name (Legal Business Name): ANNA MACEWAN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 UNION ST
BROOKLYN NY
11215-7583
US

IV. Provider business mailing address

129 W 29TH ST FL 10
NEW YORK NY
10001-5105
US

V. Phone/Fax

Practice location:
  • Phone: 212-624-1077
  • Fax: 212-867-4353
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-520-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 340892
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: