Basic Information
| Provider Information | |||||||||
| NPI: | 1841656204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAINE | ||||||||
| FirstName: | MYAH | ||||||||
| MiddleName: | ANGELICA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 HASTINGS WAY | ||||||||
| Address2: | UNIT A | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080541805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035096894 | ||||||||
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| Practice Location | |||||||||
| Address1: | 530 1ST AVE | ||||||||
| Address2: | SUITE 5 D | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122637951 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2016 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F1115295 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.