MEDICARE: JENNIFER NINVAL 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	736642	NY

General Provider Information

NPI Number	:	1265956122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NINVAL RN

Provider Business Mailing Address
First Line	:	1322 E 83RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5102
Country	:	US
Telephone Number	:	646-240-0112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 E 83RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5102
Country	:	US
Telephone Number	:	646-240-0112
Fax Number	:

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

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	07/21/2022

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