MEDICARE: GRACE NWAKAEGO ONOVO 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	207Q00000X	Family Medicine Physician	F333959	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F402494	NY

General Provider Information

NPI Number	:	1659393510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE NWAKAEGO ONOVO FNP

Provider Business Mailing Address
First Line	:	11 EMMETT TER
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10805-1201
Country	:	US
Telephone Number	:	914-636-2765
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 GRAMATAN AVE STE 604A
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3208
Country	:	US
Telephone Number	:	838-333-0513
Fax Number	:

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	03/14/2024

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