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General NPI Number Information
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NPI Number | 1891235412
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Entity Type | Organization
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Legal Business Name | KOUDEDJA DEMBELE
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 16 LOCUST AVE
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-7331
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Country | US
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Telephone | 914-500-5929
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Fax |
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Provider Business Mailing Address
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Address Line | 16 LOCUST AVE # IH
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-7331
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Country | US
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Telephone | 914-500-5929
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | MS. KOUDEDJA DEMBELE
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Credential | FNP
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Telephone | 914-500-5929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | F338512-1
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License Number State | NY
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