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General NPI Number Information
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NPI Number | 1629734298
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Entity Type | Individual
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Provider Name | MONIFA N THELWELL
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1481 MCDONALD AVE FL 2
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City | BROOKLYN
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State | NY
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Zip | 11230-4667
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Country | US
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Telephone | 929-491-7333
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Fax | 215-714-2210
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Provider Business Mailing Address
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Address Line | 405 N LINE ST
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City | LANSDALE
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State | PA
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Zip | 19446-2755
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Country | US
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Telephone | 305-978-6086
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Fax | 800-564-5952
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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 | 12567
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APN0999269-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP024065
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License Number State | PA
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