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General NPI Number Information
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NPI Number | 1477399871
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEALTHCARE PORT JERVIS FAMILY HEALTH NURSE PRACTITIONER PLLC
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Dates
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Enumeration Date | 07/04/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 32 BALL ST
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City | PORT JERVIS
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State | NY
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Zip | 12771-2404
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Country | US
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Telephone | 845-204-8204
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Fax | 918-398-9354
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Provider Business Mailing Address
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Address Line | PO BOX 48
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City | PORT JERVIS
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State | NY
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Zip | 12771-0048
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Country | US
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Telephone | 845-204-8204
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Fax | 918-398-8354
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | ROSELLE AGUILA LITTLE
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Credential | FNP-C
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Telephone | 845-204-8204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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