MEDICARE: MISS NATHALIE DELVA-JEMMOTT 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	363LA2200X	Adult Health Nurse Practitioner	718449-1	NY

General Provider Information

NPI Number	:	1891310629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATHALIE DELVA-JEMMOTT NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	7404 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2704
Country	:	US
Telephone Number	:	718-439-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 BROOKLYN AVE APT 213
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-1253
Country	:	US
Telephone Number	:	516-859-7196
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	02/20/2021

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