Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F403414-01 | NY |
NPI | 1033717764 |
---|---|
Provider Name | Kerrin M Nelson |
First Address | East Elmhurst, NY 11370-1604 |
Second Address | Forest Hills, NY 11375-2029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2020 |
Last Update Date | 01/04/2021 |