Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F303360 | NY |
NPI | 1033162888 |
---|---|
Provider Name | Miss Debra Jane Dermady-Ray |
First Address | Utica, NY 13502-6309 |
Second Address | Utica, NY 13502-6309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 01/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P68769 | (02) |