Grace Jetawo, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

698471-1 Issued in NY

Practice address

547 Saw Mill River Rd
Suite 3a
Ardsley, NY 10502-2143

Phone

(212) 687-7464

NPI assigned

Oct 27, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1164974069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 TWIN PINES DR",
            "address_2": "APT 13C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112391810",
            "telephone_number": "347-749-2492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "547 SAW MILL RIVER RD",
            "address_2": "SUITE 3A",
            "city": "ARDSLEY",
            "state": "NY",
            "postal_code": "105022143",
            "telephone_number": "212-687-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETAWO",
        "first_name": "GRACE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "698471-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Ardsley, NY
• Providers in Ardsley, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.