Healthcare Provider Details

I. General information

NPI: 1013556224
Provider Name (Legal Business Name): ALEXIS WEINMAN OHARA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W 15TH ST
NEW YORK NY
10011-5903
US

IV. Provider business mailing address

4 E 89TH ST APT 12G
NEW YORK NY
10128-0645
US

V. Phone/Fax

Practice location:
  • Phone: 516-695-6261
  • Fax:
Mailing address:
  • Phone: 516-695-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF431512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: