Individual provider Active NPI

Fatima Lawal

  • Medical-Surgical Registered Nurse
  • Staten Island, NY
National Provider Identifier
1639987290
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical-Surgical Registered NurseTaxonomy code 163WM0705X
License
903869 Issued in NY
Practice address
26 Ebbitts St Apt 1W
Staten Island, NY 10306-4823
Phone
(631) 452-4664
NPI assigned
Dec 27, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 903869 NY Primary

Addresses

Primary practice location

26 Ebbitts St Apt 1W
Staten Island, NY 10306-4823

Mailing address

26 Ebbitts St Apt 1W
Staten Island, NY 10306-4823
Phone (631) 452-4664

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
903869NYMDMedical-Surgical Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1735257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1639987290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 EBBITTS ST APT 1W",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064823",
            "telephone_number": "631-452-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 EBBITTS ST APT 1W",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064823",
            "telephone_number": "631-452-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWAL",
        "first_name": "FATIMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-27",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NY",
            "license": "903869",
            "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 Dec 27, 2024; 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.