Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F403403 | NY |
NPI | 1003409038 |
---|---|
Provider Name | Donovan George Cameron |
First Address | Brooklyn, NY 11236-5213 |
Second Address | Brooklyn, NY 11236-5213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2021 |
Last Update Date | 20/02/2021 |