MEDICARE: MS. ISATU D BAH NURSING

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	307852-1	NY

General Provider Information

NPI Number	:	1962776922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ISATU D BAH NURSING

Provider Business Mailing Address
First Line	:	40 GIFFORD AVE APT 4F
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-4931
Country	:	US
Telephone Number	:	201-208-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 GIFFORD AVE APT 4F
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-4931
Country	:	US
Telephone Number	:	201-208-5447
Fax Number	:

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

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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