Individual
MISS AMRU OKETA NICOLE WILKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
17742 136TH AVE, JAMAICA, NY 11434-4014
(718) 316-3972
Mailing address
17742 136TH AVE, JAMAICA, NY 11434-4014
(718) 316-3972
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
014713
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014713
NEW YORK STATE PHYSICIAN ASSISTANT LICENSE
NY
01
—
1090221
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
NY
Enumeration date
03/22/2011
Last updated
04/08/2011
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