Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 307485 | NY |
NPI | 1013383116 |
---|---|
Provider Name | Lois Shallow |
First Address | Westbury, NY 11590-1423 |
Second Address | Westbury, NY 11590-1423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 03/02/2017 |