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General NPI Number Information
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NPI Number | 1689994402
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Entity Type | Individual
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Provider Name | NYLA A LOTUS FNP
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 222 COOPER LAKE RD SE
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City | MABLETON
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State | GA
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Zip | 30126-1922
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Country | US
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Telephone | 404-775-7452
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SOUTH EVERETT ST
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City | VALLEY STREAM
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State | NY
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Zip | 11580
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Country | US
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Telephone | 516-285-0122
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Fax | 516-285-0499
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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 | RN101173
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License Number State | GA
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