Provider Demographics
NPI:1801231253
Name:NAVARRETO, WILMAN ANTONIO (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:WILMAN
Middle Name:ANTONIO
Last Name:NAVARRETO
Suffix:
Gender:M
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 145TH ST
Mailing Address - Street 2:TH 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3142
Mailing Address - Country:US
Mailing Address - Phone:347-385-1454
Mailing Address - Fax:
Practice Address - Street 1:300 W 145TH ST
Practice Address - Street 2:TH 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3142
Practice Address - Country:US
Practice Address - Phone:347-385-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401568363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health