=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154112621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIA FRANCO QUARESMA DE MOURA FNP-BC
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 161 FORT WASHINGTON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-1107
-----------------------------------------------------
Fax | 212-305-6125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 PADDINGTON RD
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-359-1389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F356213-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------