Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402385 | NY |
NPI | 1003346974 |
---|---|
Provider Name | Amanda Sara Brown |
First Address | New York, NY 10034-1159 |
Second Address | New York, NY 10034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 13/06/2018 |