Provider Demographics
NPI:1609259605
Name:SHERPA, MINGMA PHUTI (RN)
Entity Type:Individual
Prefix:
First Name:MINGMA
Middle Name:PHUTI
Last Name:SHERPA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 BRITTON AVE APT 6F
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2430
Mailing Address - Country:US
Mailing Address - Phone:718-820-3440
Mailing Address - Fax:
Practice Address - Street 1:3325 106TH ST FL 2
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1231
Practice Address - Country:US
Practice Address - Phone:347-907-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse