Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 383049 | NY |
NPI | 1023664356 |
---|---|
Provider Name | Dr. Jodi Riggs |
First Address | Chandler, AZ 85286-7543 |
Second Address | New Hyde Park, NY 11042-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2019 |
Last Update Date | 15/08/2019 |