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General NPI Number Information
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NPI Number | 1619432317
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Entity Type | Individual
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Provider Name | OMOSHUWA OMO-ABU NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 160 E 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-4744
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Country | US
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Telephone | 212-731-5350
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W 126TH ST APT 6H
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City | NEW YORK
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State | NY
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Zip | 10027-3809
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Country | US
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Telephone | 516-457-5522
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F308670-1
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License Number State | NY
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