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General NPI Number Information
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NPI Number | 1760533350
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Entity Type | Individual
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Provider Name | HOMER CUNNINGHAM-DESHONG NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 234 E 149TH ST
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City | BRONX
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State | NY
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Zip | 10451-5504
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Country | US
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Telephone | 718-579-6011
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Fax | 718-570-4822
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Provider Business Mailing Address
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Address Line | 1058 E 99TH ST
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City | BROOKLYN
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State | NY
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Zip | 11236-4414
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Country | US
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Telephone | 718-242-8578
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Fax | 718-241-8578
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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 | F303316
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License Number State | NY
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