Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | F3401711 | NY |
NPI | 1033487673 |
---|---|
Provider Name | Judith M Parker |
First Address | New York, NY 10002 |
Second Address | New York, NY 10002-4379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2011 |
Last Update Date | 11/12/2011 |