Provider Demographics
NPI:1598088627
Name:KONE, MOUHAMEDNOUR (LPN)
Entity Type:Individual
Prefix:
First Name:MOUHAMEDNOUR
Middle Name:
Last Name:KONE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 GRAND AVE
Mailing Address - Street 2:APT 3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8308
Mailing Address - Country:US
Mailing Address - Phone:718-731-2292
Mailing Address - Fax:
Practice Address - Street 1:1975 GRAND AVE
Practice Address - Street 2:APT 3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8308
Practice Address - Country:US
Practice Address - Phone:718-731-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY296560OtherLPN LICENSE