Provider Demographics
NPI:1316586290
Name:DOUMBIA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DOUMBIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 140TH ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1793
Mailing Address - Country:US
Mailing Address - Phone:646-359-3788
Mailing Address - Fax:
Practice Address - Street 1:210 W 140TH ST APT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1793
Practice Address - Country:US
Practice Address - Phone:646-359-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-25
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304793164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse