Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F403836 | NY |
NPI | 1003579020 |
---|---|
Provider Name | Jasmina Handanovic |
First Address | Ridgewood, NY 11385-4408 |
Second Address | White Plains, NY 10605-1504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2021 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003579020 | (05) | NY |
1003579020 | COMMERICAL (01) | NY |
1003579020 | MEDICAID (01) | NY |