Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 309454 | NY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 309454 | NY |
NPI | 1083256788 |
---|---|
Provider Name | Ashley Henry |
First Address | South Ozone Park, NY 11420-2117 |
Second Address | Bronx, NY 10459-2417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2019 |
Last Update Date | 10/04/2020 |