Healthcare Provider Details

I. General information

NPI: 1164889978
Provider Name (Legal Business Name): MERVELLIN OKUNOYE RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOWNSEND AVE
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

91 TOWNSEND AVE
STATEN ISLAND NY
10304-3713
US

V. Phone/Fax

Practice location:
  • Phone: 347-228-3140
  • Fax: 718-876-0390
Mailing address:
  • Phone: 347-228-3140
  • Fax: 718-876-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number625894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: