MEDICARE: EVERLAINES DE LA CARIDAD CHAPMAN VILTRES ADNP

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	363LA2200X	Adult Health Nurse Practitioner	310748	NY
2	163W00000X	Registered Nurse	95124767	CA
3	163W00000X	Registered Nurse	9470347	FL
4	163W00000X	Registered Nurse	727358	NY
5	163W00000X	Registered Nurse	26NR21742700	NJ

General Provider Information

NPI Number	:	1285084053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVERLAINES DE LA CARIDAD CHAPMAN VILTRES ADNP

Provider Business Mailing Address
First Line	:	1504 70TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3809
Country	:	US
Telephone Number	:	415-504-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5382
Country	:	US
Telephone Number	:	415-504-4241
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	01/30/2025

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