Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | X004913-1 | NY |
NPI | 1023160744 |
---|---|
Provider Name | Dr. Jeanne Edith D'brant |
First Address | Fort Salonga, NY 11768-2224 |
Second Address | Fort Salonga, NY 11768-2224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |