Healthcare Provider Details

I. General information

NPI: 1548942774
Provider Name (Legal Business Name): EVALINE OBARE FAMILY HEALTH NURSE PRACTITIONER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGH ST APT A
PEEKSKILL NY
10566-2809
US

IV. Provider business mailing address

111 HIGH ST APT A
PEEKSKILL NY
10566-2809
US

V. Phone/Fax

Practice location:
  • Phone: 914-374-8096
  • Fax:
Mailing address:
  • Phone: 914-374-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. EVALINE AWUOR OBARE
Title or Position: DIRECTOR
Credential: FNP
Phone: 914-374-8096