Individual
BERTHE QUEDRAOGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
108 W 124TH ST, NEW YORK, NY 10027-4919
(212) 961-0651
Mailing address
108 W 124TH ST, NEW YORK, NY 10027-4919
(646) 667-1808
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
722805-1
NY
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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