Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 11007897 | FL |
NPI | 1023661741 |
---|---|
Provider Name | Doreen May East |
First Address | Wellington, FL 33414-3145 |
Second Address | Wellington, FL 33414-3145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 18/03/2021 |