Healthcare Provider Details

I. General information

NPI: 1992936975
Provider Name (Legal Business Name): DUREMELLE Z. DEUTOU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date: 05/13/2014
Reactivation Date: 12/11/2019

III. Provider practice location address

46 W 137TH ST
NEW YORK NY
10037-1901
US

IV. Provider business mailing address

46 W 137TH ST
NEW YORK NY
10037-1901
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-1000
  • Fax:
Mailing address:
  • Phone: 212-939-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number610788
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF343869-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: