Provider Demographics
NPI:1194994673
Name:FORKUOH, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FORKUOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 TINTON AVE
Mailing Address - Street 2:41
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4519
Mailing Address - Country:US
Mailing Address - Phone:917-412-5048
Mailing Address - Fax:
Practice Address - Street 1:537 TINTON AVE
Practice Address - Street 2:41
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4519
Practice Address - Country:US
Practice Address - Phone:917-412-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581231-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse