Provider Demographics
NPI:1932400975
Name:SAMUEL, OMANA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:OMANA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DEKALB AVENUE
Mailing Address - Street 2:THE BROOKLYN HOSPITAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-250-6965
Mailing Address - Fax:718-250-8271
Practice Address - Street 1:121 DEKALB AVENUE
Practice Address - Street 2:THE BROOKLYN HOSPITAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-250-6965
Practice Address - Fax:718-250-8271
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF.303106-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health