MEDICARE: SALOME AYISA KPAGA 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	163WG0000X	General Practice Registered Nurse	840438-01	NY

General Provider Information

NPI Number	:	1245104843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALOME AYISA KPAGA RN

Provider Business Mailing Address
First Line	:	327 E 206TH ST APT 39
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-4082
Country	:	US
Telephone Number	:	929-426-9148
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 E 206TH ST APT 39
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-4082
Country	:	US
Telephone Number	:	929-426-9148
Fax Number	:

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

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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