Provider Demographics
NPI:1669443396
Name:EMILIEN, MONA BEAUCHAMP (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:BEAUCHAMP
Last Name:EMILIEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:31 EAST 31 STREET
Mailing Address - Street 2:APT 1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:347-413-5076
Mailing Address - Fax:718-245-2552
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-2983
Practice Address - Fax:718-245-2552
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF334256-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily