Individual provider Active NPI

Mamita S Amevuvor, LPN

  • Licensed Practical Nurse
  • Staten Island, NY
National Provider Identifier
1578857918
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
304504-1 Issued in NY
Practice address
260 Park Hill Ave Apt 4X
Staten Island, NY 10304-4646
Phone
(347) 933-8598
NPI assigned
Jun 2, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 304504-1 NY Primary

Addresses

Primary practice location

260 Park Hill Ave Apt 4X
Staten Island, NY 10304-4646

Mailing address

260 Park Hill Ave Apt 4X
Staten Island, NY 10304-4646
Phone (347) 933-8598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
304504-1NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1578857918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 PARK HILL AVE APT 4X",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044646",
            "telephone_number": "347-933-8598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 PARK HILL AVE APT 4X",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044646",
            "telephone_number": "347-933-8598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMEVUVOR",
        "first_name": "MAMITA",
        "middle_name": "S",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "304504-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; 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.