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General NPI Number Information
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NPI Number | 1811260110
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Entity Type | Individual
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Provider Name | EMANCIA MYRIE
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Gender | Female
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 999 BLAKE AVENUE
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City | BROOKLYN
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State | USA
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Zip | 11208
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Country | UM
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Telephone | 718-277-8303
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Fax | 718-277-4795
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Provider Business Mailing Address
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Address Line | 60 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10010-1600
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Country | US
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Telephone | 212-545-2400
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Fax | 646-312-0481
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F401426-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 478347-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 478347-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401426
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License Number State | NY
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