Provider Demographics
NPI:1720743677
Name:HAROUN, RITA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:HAROUN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 LAMOKA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3437
Mailing Address - Country:US
Mailing Address - Phone:718-406-6774
Mailing Address - Fax:
Practice Address - Street 1:584 LAMOKA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3437
Practice Address - Country:US
Practice Address - Phone:718-406-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY564487-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health