Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 309186 | NY |
NPI | 1023662640 |
---|---|
Provider Name | Ann Shum |
First Address | New York, NY 10032-3917 |
Second Address | New York, NY 10032-3917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2019 |
Last Update Date | 31/07/2019 |