Provider Demographics
NPI:1467855486
Name:NAVVAB, MINNA (PMHNP-BC, CNM)
Entity Type:Individual
Prefix:
First Name:MINNA
Middle Name:
Last Name:NAVVAB
Suffix:
Gender:F
Credentials:PMHNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VARICK ST RM 900
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4893
Mailing Address - Country:US
Mailing Address - Phone:212-620-0340
Mailing Address - Fax:
Practice Address - Street 1:200 VARICK ST RM 900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4893
Practice Address - Country:US
Practice Address - Phone:212-620-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-04
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241876367A00000X
NY001855367A00000X
NY404740363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1467855486Medicaid