Provider Demographics
NPI:1376857193
Name:AMALU, DORIS (RN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:AMALU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 BOUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2920
Mailing Address - Country:US
Mailing Address - Phone:347-932-2472
Mailing Address - Fax:
Practice Address - Street 1:1052 ANDERSON AVE
Practice Address - Street 2:APT-2C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5348
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346824-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care