MEDICARE: HAWA GABRIEL 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	163WS0200X	School Registered Nurse	657288	NY

General Provider Information

NPI Number	:	1346750973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAWA GABRIEL RN

Provider Business Mailing Address
First Line	:	2229 NEWBOLD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5107
Country	:	US
Telephone Number	:	617-735-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 NEWBOLD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5107
Country	:	US
Telephone Number	:	617-735-5422
Fax Number	:

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

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	10/10/2017

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