MEDICARE: MRS. DONAIRE H HOWARD RN FNP BS MSW

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	3021991	NY
2	163WG0000X	General Practice Registered Nurse	3021991	NY
3	1041C0700X	Clinical Social Worker	SW992133	ZZ
4	363LF0000X	Family Nurse Practitioner	NP9921301	ZZ

General Provider Information

NPI Number	:	1962588723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONAIRE H HOWARD RN FNP BS MSW

Provider Business Mailing Address
First Line	:	PO BOX 0891
Second Line	:	800 MANOR RD 2V PROFESSIONAL SUITES KABBALAH VISITING N
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-0891
Country	:	US
Telephone Number	:	718-720-0292
Fax Number	:	718-761-5562

Provider Business Practice Location Address
First Line	:	800 MANOR RD
Second Line	:	PROFESSIONAL SUITES 2V
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7016
Country	:	US
Telephone Number	:	347-613-7836
Fax Number	:	718-761-5562

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/23/2008

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