Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN 144234 | GA |
NPI | 1003013236 |
---|---|
Provider Name | Mary Eva Ostaszewski |
First Address | Cumming, GA 30041-1469 |
Second Address | Sugar Hill, GA 30518-3480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 16/02/2010 |