Individual
BENEDETTE EYIUCHE IBENEGBU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 556-1708
Mailing address
128 BLACKFORD AVE, STATEN ISLAND, NY 10302-1617
(718) 556-1708
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
526977-1
NY
363LF0000X
Family Nurse Practitioner
Primary
F337167-1
NY
Other
Enumeration date
07/23/2014
Last updated
07/23/2014
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