Provider Demographics
NPI:1881939411
Name:AKOTOH, MAVIS (RN)
Entity type:Individual
Prefix:MISS
First Name:MAVIS
Middle Name:
Last Name:AKOTOH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 WALTON AVE
Mailing Address - Street 2:APT. 2J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8455
Mailing Address - Country:US
Mailing Address - Phone:718-293-2365
Mailing Address - Fax:
Practice Address - Street 1:1170 WALTON AVE
Practice Address - Street 2:APT. 2J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8455
Practice Address - Country:US
Practice Address - Phone:718-293-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY652483-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse