Provider Demographics
NPI:1285277079
Name:MOBILE ADULT NURSE PRACTITIONER SERVICES PLLC
Entity type:Organization
Organization Name:MOBILE ADULT NURSE PRACTITIONER SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAISOME
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-748-5699
Mailing Address - Street 1:66 MAIN ST APT 607
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-8854
Mailing Address - Country:US
Mailing Address - Phone:917-748-5699
Mailing Address - Fax:
Practice Address - Street 1:66 MAIN ST APT 607
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-8854
Practice Address - Country:US
Practice Address - Phone:917-748-5699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty