Provider Demographics
NPI:1578857918
Name:AMEVUVOR, MAMITA S (LPN)
Entity Type:Individual
Prefix:
First Name:MAMITA
Middle Name:S
Last Name:AMEVUVOR
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 1:260 PARK HILL AVE APT 4X
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4646
Mailing Address - Country:US
Mailing Address - Phone:347-933-8598
Mailing Address - Fax:
Practice Address - Street 1:260 PARK HILL AVE APT 4X
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4646
Practice Address - Country:US
Practice Address - Phone:347-933-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304504-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse