MEDICARE: FREDERICA MORRISON-QUAMINA 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	648431	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	648431	OTHER	NY	RN LICENSE

General Provider Information

NPI Number	:	1699059048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICA MORRISON-QUAMINA RN

Provider Business Mailing Address
First Line	:	220 MONTGOMERY ST
Second Line	:	APT 16D
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2032
Country	:	US
Telephone Number	:	718-774-7865
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 MONTGOMERY ST
Second Line	:	APT 16D
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2032
Country	:	US
Telephone Number	:	718-774-7865
Fax Number	:

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

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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