Provider Demographics
NPI:1003272865
Name:KO, EUNAE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EUNAE
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365A W 28TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4703
Mailing Address - Country:US
Mailing Address - Phone:212-741-3030
Mailing Address - Fax:
Practice Address - Street 1:365A W 28TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4703
Practice Address - Country:US
Practice Address - Phone:212-741-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00610300363LP2300X
NY308083363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care