Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1173 | OR |
NPI | 1073055745 |
---|---|
Provider Name | Dr. Raffaella Maria Marcantonio |
First Address | Kenmore, NY 14217-1002 |
Second Address | Kenmore, NY 14217-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2016 |
Last Update Date | 13/11/2016 |