Provider Demographics
NPI:1497934269
Name:HAM, KIRSIS ALMANZAR (BSN, MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIRSIS
Middle Name:ALMANZAR
Last Name:HAM
Suffix:
Gender:F
Credentials:BSN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BOX 566
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-4166
Mailing Address - Fax:212-746-8852
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX 566
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4166
Practice Address - Fax:212-746-8852
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily