Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 587019 | NY |
NPI | 1073829503 |
---|---|
Provider Name | Miss Jessica Lynne Mollard-Zimmerman |
First Address | Glenville, NY 12302-3735 |
Second Address | Rahway, NJ 07065-2521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2010 |
Last Update Date | 06/08/2019 |