Provider Demographics
NPI:1649514829
Name:EVWERHAMRE, EMUOBOSA CHARLES (LPN)
Entity type:Individual
Prefix:MR
First Name:EMUOBOSA
Middle Name:CHARLES
Last Name:EVWERHAMRE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 LAFAYETTE AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2009
Mailing Address - Country:US
Mailing Address - Phone:646-407-1657
Mailing Address - Fax:
Practice Address - Street 1:2016 LAFAYETTE AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2009
Practice Address - Country:US
Practice Address - Phone:646-407-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311758164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse