Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 304069 | NY |
NPI | 1003938614 |
---|---|
Provider Name | Idania Flete-Olmeda |
First Address | New York, NY 10021-6007 |
Second Address | New York, NY 10021-6007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |