MEDICARE: NTOZAKE ESCOURSE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	829645-01	NJ

General Provider Information

NPI Number	:	1205596293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NTOZAKE ESCOURSE RN

Provider Business Mailing Address
First Line	:	558 MCCHESNEY ST UNIT 1
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-1219
Country	:	US
Telephone Number	:	347-633-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	558 MCCHESNEY ST UNIT 1
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-1219
Country	:	US
Telephone Number	:	347-633-5550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2021
Last Update Date	:	12/18/2021

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