Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F38309-1 | NY |
NPI | 1063712446 |
---|---|
Provider Name | Lucia Dispigno |
First Address | New Hyde Park, NY 11040-1433 |
Second Address | New Hyde Park, NY 11040-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 21/08/2012 |