=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992787469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JO ANN FIELDS NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 AVENUE OF THE AMERICAS AHC
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-941-9090
-----------------------------------------------------
Fax | 212-941-9614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 W 85TH ST APT. 4A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-799-0830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | F420335-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------