Healthcare Provider Details

I. General information

NPI: 1619377066
Provider Name (Legal Business Name): URSZULA WHITMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 66TH ST APT 2L
GLENDALE NY
11385-7009
US

IV. Provider business mailing address

7114 66TH ST APT 2L
GLENDALE NY
11385-7009
US

V. Phone/Fax

Practice location:
  • Phone: 718-821-6659
  • Fax:
Mailing address:
  • Phone: 718-821-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number666488-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: