Provider Demographics
NPI:1083147003
Name:IBENEME, VERONICA NGOZI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:NGOZI
Last Name:IBENEME
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 OCEAN AVE
Mailing Address - Street 2:1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2542
Mailing Address - Country:US
Mailing Address - Phone:866-551-9700
Mailing Address - Fax:
Practice Address - Street 1:1299 OCEAN AVE
Practice Address - Street 2:1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2542
Practice Address - Country:US
Practice Address - Phone:866-551-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404253363LP0808X
NY620960163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse