Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 28254097A | IN |
NPI | 1083263628 |
---|---|
Provider Name | Caitlyn O'neil |
First Address | Louisville, KY 40202-4713 |
Second Address | Westbury, NY 11590-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 23/06/2021 |