Individual
AWELE IDEMUDIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26 DUMONT AVE, STATEN ISLAND, NY 10305-1450
(718) 667-4282
Mailing address
117 S 13TH ST APT 2, NEWARK, NJ 07107-4238
(347) 866-4489
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
Primary
564012
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I18210716553512
DRIVER'S LICENSE
NJ
Enumeration date
07/29/2022
Last updated
07/29/2022
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