Healthcare Provider Details

I. General information

NPI: 1508176140
Provider Name (Legal Business Name): STELLA N NJOKU LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BEACH ST
STATEN ISLAND NY
10304-2702
US

IV. Provider business mailing address

6 WOODLAND AVE APT 31
KEARNY NJ
07032
US

V. Phone/Fax

Practice location:
  • Phone: 718-815-8089
  • Fax: 718-815-8062
Mailing address:
  • Phone: 201-927-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number299780
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number299780-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: