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Individual

MRS. EJIROGHENE IDOLOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
X
Credential
MSN, AGPCNP-BC

Contact information

Practice address
1250 GRANT AVE APT 3, BRONX, NY 10456-3191
(803) 290-6363
Mailing address
1250 GRANT AVE APT 3, BRONX, NY 10456-3191
(803) 290-6363

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
311110
NY

Other

Enumeration date
04/07/2025
Last updated
04/07/2025
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