Provider Demographics
NPI:1639816044
Name:DRAKE, WILHELMINIA KAYLA DEVON (NP)
Entity Type:Individual
Prefix:MRS
First Name:WILHELMINIA
Middle Name:KAYLA DEVON
Last Name:DRAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:WILHELMINIA
Other - Middle Name:KAYLA DEVON
Other - Last Name:HYPOLITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WILHELMINIA HYPOLITE
Mailing Address - Street 1:18 FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7108
Mailing Address - Country:US
Mailing Address - Phone:516-476-3570
Mailing Address - Fax:
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1347
Practice Address - Country:US
Practice Address - Phone:516-562-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF432316-01163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUNKNOWNMedicaid