1659636033 NPI number — MRS. CAROLLE KEBREAU NURSE PRACTITIONER,

Table of content: MRS. CAROLLE KEBREAU NURSE PRACTITIONER, (NPI 1659636033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659636033 NPI number — MRS. CAROLLE KEBREAU NURSE PRACTITIONER,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEBREAU
Provider First Name:
CAROLLE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659636033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 BROADWAY, DEPARTMENT OF MANAGED CARE ROOM 2B-230
Provider Second Line Business Mailing Address:
ATTN: CAROLLE KEBREAU, NP - WOODHULL HOSPITAL
Provider Business Mailing Address City Name:
WEST HEMPSTEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11552-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-486-2732
Provider Business Mailing Address Fax Number:
718-630-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 BROADWAY - WOODHULL HOSPITAL CENTER
Provider Second Line Business Practice Location Address:
MANAGED CARE DEPARTMENT ROOM 2B-230
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-486-2732
Provider Business Practice Location Address Fax Number:
718-486-2732
Provider Enumeration Date:
07/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F3369701 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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