Provider Demographics
NPI:1225812332
Name:TAILORED HEALTHCARE SERVICES-NURSE PRACTITIONER IN ADULT HEALTH
Entity Type:Organization
Organization Name:TAILORED HEALTHCARE SERVICES-NURSE PRACTITIONER IN ADULT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINSOME
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-286-1884
Mailing Address - Street 1:9621 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9621 AVENUE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1321
Practice Address - Country:US
Practice Address - Phone:347-286-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center