Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F306811 | NY |
N | 363LG0600X | Nurse Practitioner - Gerontology | F340939 | NY |
NPI | 1053710962 |
---|---|
Provider Name | Diana Denisova |
First Address | Brooklyn, NY 11224-3700 |
Second Address | Brooklyn, NY 11224-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 15/08/2014 |