Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F341411-1 | NY |
NPI | 1962921775 |
---|---|
Provider Name | Lelieth Lorraine Bailey-Williams |
First Address | Cambria Heights, NY 11411-1117 |
Second Address | Brooklyn, NY 11220-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 12/09/2017 |