Provider Demographics
NPI:1710182860
Name:ASEMOTA, ELAINE FAITH
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:FAITH
Last Name:ASEMOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:FAITH
Other - Last Name:ALAKETU NEE ASEMOTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:32 ORMOND ST
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6333
Mailing Address - Country:US
Mailing Address - Phone:631-940-0604
Mailing Address - Fax:631-940-0604
Practice Address - Street 1:32 ORMOND ST
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6333
Practice Address - Country:US
Practice Address - Phone:631-940-0604
Practice Address - Fax:631-940-0604
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY545664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse