Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 347039 | NY |
NPI | 1003239831 |
---|---|
Provider Name | Kauniko Mccormick |
First Address | Bronx, NY 10475-1704 |
Second Address | Bronx, NY 10475-1704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2014 |
Last Update Date | 06/05/2021 |