Healthcare Provider Details

I. General information

NPI: 1922723725
Provider Name (Legal Business Name): JAMIE REBECCA HYATT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-36 33RD ST SUITE 311
LONG ISLAND CITY NY
11106-2329
US

IV. Provider business mailing address

36-36 33RD STREET SUITE 311
LONG ISLAND CITY NY
11106
US

V. Phone/Fax

Practice location:
  • Phone: 718-704-5376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number817761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: