MEDICARE: MISS HABEEBAT A LAWAL 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	621302	NY
2	363LA2200X	Adult Health Nurse Practitioner	309979	NY

General Provider Information

NPI Number	:	1528399367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HABEEBAT A LAWAL RN

Provider Business Mailing Address
First Line	:	216 ROCKAWAY AVE APT 22A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4222
Country	:	US
Telephone Number	:	718-915-7317
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 ROCKAWAY AVE APT 22A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4222
Country	:	US
Telephone Number	:	718-915-7317
Fax Number	:

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

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	10/04/2020

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