Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F343094 | NY |
NPI | 1003170275 |
---|---|
Provider Name | Latoya Betton |
First Address | Bronx, NY 10461-2507 |
Second Address | Bronx, NY 10453-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2012 |
Last Update Date | 03/10/2019 |