=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336748136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPHA HOUSE CALLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2020
-----------------------------------------------------
Last Update Date | 10/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 FERNGLADE CT
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10918-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-309-7994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 FERNGLADE CT
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10918-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-309-7994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. TASHA SMITH
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 914-309-7994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------