Provider Demographics
NPI:1063702967
Name:IBRAHIM, NURA ABDUL-MUMUNI (LPN)
Entity type:Individual
Prefix:MISS
First Name:NURA
Middle Name:ABDUL-MUMUNI
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 SHAKESPEARE AVE
Mailing Address - Street 2:4E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3021
Mailing Address - Country:US
Mailing Address - Phone:347-209-8551
Mailing Address - Fax:
Practice Address - Street 1:1246 SHAKESPEARE AVE
Practice Address - Street 2:4E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3021
Practice Address - Country:US
Practice Address - Phone:347-209-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302904164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse