Provider Demographics
NPI:1730414772
Name:JIBRIL, SAMIRA
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:JIBRIL
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 1:610 WARING AVE
Mailing Address - Street 2:1U
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7707
Mailing Address - Country:US
Mailing Address - Phone:718-652-1569
Mailing Address - Fax:
Practice Address - Street 1:610 WARING AVE
Practice Address - Street 2:1U
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7707
Practice Address - Country:US
Practice Address - Phone:718-652-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY546937164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse