Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F302011 | NY |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | F302011 | NY |
NPI | 1366448151 |
---|---|
Provider Name | Mary Carter |
First Address | Melville, NY 11747 |
Second Address | Syosset, NY 11791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265349 | (02) | NY |