Provider Demographics
NPI:1972822179
Name:MOMANYI, FLORENCE
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:MOMANYI
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 1:314 OLD TUXEDO RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4564
Mailing Address - Country:US
Mailing Address - Phone:845-477-2009
Mailing Address - Fax:
Practice Address - Street 1:314 OLD TUXEDO RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4564
Practice Address - Country:US
Practice Address - Phone:845-477-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01000288484164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse