Provider Demographics
NPI:1891065249
Name:NNEBE, JONATHAN (BSN/RN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NNEBE
Suffix:
Gender:M
Credentials:BSN/RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14866 262ND PL
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3008
Mailing Address - Country:US
Mailing Address - Phone:718-525-7233
Mailing Address - Fax:
Practice Address - Street 1:14866 262ND PL
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3008
Practice Address - Country:US
Practice Address - Phone:718-525-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse