Provider Demographics
NPI:1700139839
Name:OHAKAM, PHINNAH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PHINNAH
Middle Name:
Last Name:OHAKAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SPLIT CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1627
Mailing Address - Country:US
Mailing Address - Phone:631-234-9136
Mailing Address - Fax:
Practice Address - Street 1:3 SURREY LN
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2536
Practice Address - Country:US
Practice Address - Phone:631-503-7209
Practice Address - Fax:631-909-2445
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265481164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse