Provider Demographics
NPI:1518382696
Name:GEORGE, EGUOLO
Entity Type:Individual
Prefix:
First Name:EGUOLO
Middle Name:
Last Name:GEORGE
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 1:1600 WEBSTER AVE
Mailing Address - Street 2:ROOM 107
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8059
Mailing Address - Country:US
Mailing Address - Phone:718-731-0308
Mailing Address - Fax:718-731-0308
Practice Address - Street 1:1600 WEBSTER AVE
Practice Address - Street 2:ROOM 107
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8059
Practice Address - Country:US
Practice Address - Phone:718-731-0308
Practice Address - Fax:718-731-0308
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY615372163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool