Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 350394 | NY |
NPI | 1265807846 |
---|---|
Provider Name | Colleen Carmody |
First Address | Massapequa, NY 11758-6422 |
Second Address | Massapequa, NY 11758-6422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2015 |
Last Update Date | 08/12/2015 |