Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 403752 | NY |
NPI | 1013660588 |
---|---|
Provider Name | Allison Marie Kornahrens |
First Address | Bay Shore, NY 11706-4514 |
Second Address | Bay Shore, NY 11706-4514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2022 |
Last Update Date | 03/02/2022 |