Healthcare Provider Details

I. General information

NPI: 1295926491
Provider Name (Legal Business Name): AUDREY CESARINE KLEET ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH12
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST PH12
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3824
  • Fax: 212-305-7439
Mailing address:
  • Phone: 212-305-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430357
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00264600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: