Individual
MRS. EREWARIFAGHA MININI HAIDOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
14036 170TH ST, JAMAICA, NY 11434-4632
(347) 843-7760
Mailing address
3963 MURDOCK AVE, BRONX, NY 10466-2442
(347) 281-0304
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
621055-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403564
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114301728
NPI
NY
Enumeration date
07/13/2015
Last updated
11/02/2023
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