Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | F431531-01 | NY |
NPI | 1033777073 |
---|---|
Provider Name | Miss Jennifer Lee Solan |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Commack, NY 11725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 02/09/2019 |