Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402744 | NY |
NPI | 1003476888 |
---|---|
Provider Name | Maribeth Evans |
First Address | Binghamton, NY 13905 |
Second Address | Binghamton, NY 13903-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 06/08/2019 |