Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F307015-1 | NY |
NPI | 1003214628 |
---|---|
Provider Name | Genevieve Spota |
First Address | Staten Island, NY 10306-2241 |
Second Address | Staten Island, NY 10306-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2014 |
Last Update Date | 13/12/2014 |