Provider Demographics
NPI:1215186499
Name:ATUEGWU, EDITH (RN)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:ATUEGWU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PINE STREET 17TH FLOOR
Mailing Address - Street 2:ODYSSEY HOUSE, INC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005
Mailing Address - Country:US
Mailing Address - Phone:212-987-5133
Mailing Address - Fax:
Practice Address - Street 1:219 E 121ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3018
Practice Address - Country:US
Practice Address - Phone:212-987-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00452134163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00452134Medicaid