Provider Demographics
NPI:1447549894
Name:BAMAWO, PRECIOUS (FNP)
Entity type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:
Last Name:BAMAWO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6209
Mailing Address - Country:US
Mailing Address - Phone:516-798-1800
Mailing Address - Fax:516-798-1563
Practice Address - Street 1:5353 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6209
Practice Address - Country:US
Practice Address - Phone:516-798-1800
Practice Address - Fax:631-422-3398
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647513163W00000X
NYF345634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse