Provider Demographics
NPI:1235767146
Name:NNENNA NP IN FAMILY HEALTH PRACTICE PLLC
Entity Type:Organization
Organization Name:NNENNA NP IN FAMILY HEALTH PRACTICE PLLC
Other - Org Name:NNENNA NP IN FAMILY HEALTH PRACTICE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:NNENNA
Authorized Official - Last Name:ORJI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:347-951-4301
Mailing Address - Street 1:796 THOMAS S BOYLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4433
Mailing Address - Country:US
Mailing Address - Phone:347-951-4301
Mailing Address - Fax:718-455-0999
Practice Address - Street 1:796 SARATOGA AVE STE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4475
Practice Address - Country:US
Practice Address - Phone:347-365-9779
Practice Address - Fax:347-365-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-28
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05557268Medicaid
NY06071058Medicaid
NY=========OtherIRS