Provider Demographics
NPI:1972801439
Name:LETTIERI, RUVIMBO HAZEL
Entity Type:Individual
Prefix:MRS
First Name:RUVIMBO
Middle Name:HAZEL
Last Name:LETTIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUVINBO
Other - Middle Name:HAZEL
Other - Last Name:NYAKURIMWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0423
Mailing Address - Country:US
Mailing Address - Phone:917-346-5039
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4870
Practice Address - Country:US
Practice Address - Phone:631-654-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342397-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily