Healthcare Provider Details

I. General information

NPI: 1881150043
Provider Name (Legal Business Name): CHRISTINA ANN PERSAUD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ANN PERSAUD FNP-BC

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LANE AVE
PLAINVIEW NY
11803-5206
US

IV. Provider business mailing address

9 LANE AVE
PLAINVIEW NY
11803-5206
US

V. Phone/Fax

Practice location:
  • Phone: 646-372-6184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338429-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: