Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F340955-1 | NY |
NPI | 1003338153 |
---|---|
Provider Name | Julie Minogue |
First Address | Maspeth, NY 11378-2814 |
Second Address | Maspeth, NY 11378-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 11/07/2017 |