Provider Demographics
NPI:1992825632
Name:WALRAVEN, OURANIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:OURANIA
Middle Name:
Last Name:WALRAVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HATFIELD LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6734
Mailing Address - Country:US
Mailing Address - Phone:845-294-7700
Mailing Address - Fax:845-294-5363
Practice Address - Street 1:70 HATFIELD LN
Practice Address - Street 2:SUITE 203
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6734
Practice Address - Country:US
Practice Address - Phone:845-294-7700
Practice Address - Fax:845-294-5363
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3039041363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03843872Medicaid
NY03843872Medicaid