Provider Demographics
NPI:1306138615
Name:OTISI, IFEOMA SUNDAY (LPN)
Entity type:Individual
Prefix:MISS
First Name:IFEOMA
Middle Name:SUNDAY
Last Name:OTISI
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 1:19006 HOLLIS AVE
Mailing Address - Street 2:1ST FL.
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2829
Mailing Address - Country:US
Mailing Address - Phone:347-613-5268
Mailing Address - Fax:
Practice Address - Street 1:19006 HOLLIS AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2829
Practice Address - Country:US
Practice Address - Phone:347-613-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304927-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse