MEDICARE: CORETHA ARYEEQUAYE

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	164W00000X	Licensed Practical Nurse	251173	NY

General Provider Information

NPI Number	:	1215180344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORETHA ARYEEQUAYE

Provider Business Mailing Address
First Line	:	3435 GILES PL
Second Line	:	APT 4E
City	:	BRONX
State	:	NY
Zip	:	10463-4336
Country	:	US
Telephone Number	:	718-601-4886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 GILES PL
Second Line	:	APT 4E
City	:	BRONX
State	:	NY
Zip	:	10463-4336
Country	:	US
Telephone Number	:	718-601-4886
Fax Number	:

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

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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Directions to “ CORETHA ARYEEQUAYE ” Practice Location

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