Provider Demographics
NPI:1437322369
Name:MOKAU, ELLEN MATHIPA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MATHIPA
Last Name:MOKAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WANDA PLACE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2057
Mailing Address - Country:US
Mailing Address - Phone:631-696-1826
Mailing Address - Fax:
Practice Address - Street 1:12 WANDA PLACE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2057
Practice Address - Country:US
Practice Address - Phone:631-696-1826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2754551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse