MEDICARE: MOUHAMEDNOUR KONE LPN

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	164W00000X	Licensed Practical Nurse	296560	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	296560	OTHER	NY	LPN LICENSE

General Provider Information

NPI Number	:	1598088627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUHAMEDNOUR KONE LPN

Provider Business Mailing Address
First Line	:	1975 GRAND AVE
Second Line	:	APT 3B
City	:	BRONX
State	:	NY
Zip	:	10453-8308
Country	:	US
Telephone Number	:	718-731-2292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 GRAND AVE
Second Line	:	APT 3B
City	:	BRONX
State	:	NY
Zip	:	10453-8308
Country	:	US
Telephone Number	:	718-731-2292
Fax Number	:

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

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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