Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F381491 | NY |
NPI | 1003034174 |
---|---|
Provider Name | Maureen Licursi |
First Address | New York, NY 10032-3729 |
Second Address | New York, NY 10032-3729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |