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General NPI Number Information
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NPI Number | 1588130058
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Entity Type | Individual
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Provider Name | EDNA KERUBO AKOMBE APN
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Gender | Female
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 40 UNION AVE STE 3
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City | IRVINGTON
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State | NJ
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Zip | 07111-3277
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Country | US
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Telephone | 862-849-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 40 UNION AVE STE 3
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City | IRVINGTON
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State | NJ
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Zip | 07111-3277
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Country | US
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Telephone | 862-849-2618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00854300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 26NJ00854300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP500023507
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License Number State | DC
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