Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 340954 | NY |
NPI | 1003362682 |
---|---|
Provider Name | Michelle Rising |
First Address | Binghamton, NY 13905-1048 |
Second Address | Candor, NY 13743-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |