Provider Demographics
NPI:1336471200
Name:URENA, MILDRED
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:URENA
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 1:140 DE KRUIF PL
Mailing Address - Street 2:APT 28K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2201
Mailing Address - Country:US
Mailing Address - Phone:347-205-1492
Mailing Address - Fax:
Practice Address - Street 1:140 DE KRUIF PL
Practice Address - Street 2:APT 28K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2201
Practice Address - Country:US
Practice Address - Phone:347-205-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153712-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse