Provider Demographics
NPI:1972999589
Name:IGBO-AWE, ROSE (NP-C)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:IGBO-AWE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1013
Mailing Address - Country:US
Mailing Address - Phone:718-866-7221
Mailing Address - Fax:
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5315
Practice Address - Country:US
Practice Address - Phone:516-622-7944
Practice Address - Fax:516-622-7957
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306702-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health