Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 9255239 | FL |
NPI | 1134616956 |
---|---|
Provider Name | Lianely Marciante |
First Address | Lake Worth, FL 33463-7362 |
Second Address | Lake Worth, FL 33463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 31/07/2018 |