Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 334537 | NY |
NPI | 1619218948 |
---|---|
Provider Name | Agnes Christina Eytle-Adams |
First Address | New York, NY 10004-2415 |
Second Address | New York, NY 10004-2415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
334537 | LICENSE # (01) | NY |