Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F302099 | NY |
NPI | 1013097666 |
---|---|
Provider Name | Maria Serrano |
First Address | Valhalla, NY 10595-1418 |
Second Address | Bronx, NY 10467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |