Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R183748 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R183748 | MD |
N | 363LP2300X | Nurse Practitioner - Primary Care | R183748 | MD |
NPI | 1063099547 |
---|---|
Provider Name | Michelle Lorenzo Diaz |
First Address | White Plains, MD 20695-4231 |
Second Address | White Plains, MD 20695-3077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 19/06/2021 |