Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 320093 | NY |
NPI | 1184076457 |
---|---|
Provider Name | Mary Veronica Carson |
First Address | Lima, NY 14485-9755 |
Second Address | Rochester, NY 14618-5647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 29/11/2018 |