Healthcare Provider Details

I. General information

NPI: 1891004909
Provider Name (Legal Business Name): MIRRIAM KUYELI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E 3RD ST APT-A22
MOUNT VERNON NY
10550-3953
US

IV. Provider business mailing address

23 E 3RD ST APT-A22
MOUNT VERNON NY
10550-3953
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 718-671-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number293185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: