MEDICARE: MISS PAULA DICOLA COMRIE NURSE PRACTITIONER

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	F339590-1	NY

General Provider Information

NPI Number	:	1497100192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAULA DICOLA COMRIE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1212 E 224TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5806
Country	:	US
Telephone Number	:	646-872-0201
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 W 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4701
Country	:	US
Telephone Number	:	212-926-5050
Fax Number	:

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

Provider Enumeration Date	:	04/30/2016
Last Update Date	:	04/30/2016

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