Provider Demographics
NPI:1275980815
Name:TRAWALLEH, NJANKO (LPN-PRACTICAL NURSE)
Entity Type:Individual
Prefix:
First Name:NJANKO
Middle Name:
Last Name:TRAWALLEH
Suffix:
Gender:M
Credentials:LPN-PRACTICAL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 BRIGGS AVE
Mailing Address - Street 2:APT. D4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4006
Mailing Address - Country:US
Mailing Address - Phone:917-293-2412
Mailing Address - Fax:
Practice Address - Street 1:2695 BRIGGS AVE
Practice Address - Street 2:APT. D4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4006
Practice Address - Country:US
Practice Address - Phone:917-293-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315411164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse