Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F421201 | NY |
NPI | 1083096291 |
---|---|
Provider Name | Connie Mui |
First Address | Staten Island, NY 10306-6135 |
Second Address | New York, NY 10016-9196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 08/08/2017 |