Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F000088 | NY |
NPI | 1104988849 |
---|---|
Provider Name | Madonna Holder |
First Address | Brooklyn, NY 11201 |
Second Address | Brooklyn, NY 11201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01859723 | (05) | NY |