Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 332621 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 332621 | NY |
NPI | 1043521511 |
---|---|
Provider Name | Donna Jean Hannigan |
First Address | Kingston, NY 12401-3739 |
Second Address | Kingston, NY 12401-3739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 29/06/2010 |