MEDICARE: IZABELA OKON FNP

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	363LF0000X	Family Nurse Practitioner	525031	NY

General Provider Information

NPI Number	:	1306308200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IZABELA OKON FNP

Provider Business Mailing Address
First Line	:	275 WEBSTER AVE APT 4E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1232
Country	:	US
Telephone Number	:	917-664-2916
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 41ST ST STE M1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1105
Country	:	US
Telephone Number	:	718-438-2295
Fax Number	:

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	04/01/2019

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