Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F332624 | NY |
NPI | 1013024256 |
---|---|
Provider Name | Joan Eckert |
First Address | Rochester, NY 14642-0001 |
Second Address | Rochester, NY 14642-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 26/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02371479 | (05) | NY |
NP0672 | PREFERRED CARE (01) | NY |
P019332624 | BLUE CHOICE (01) | NY |
S88407 | (02) | NY |