Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305880-1 | NY |
NPI | 1013287697 |
---|---|
Provider Name | Miss Mary Christine Salita Mendoza |
First Address | Weehawken, NJ 07086-6899 |
Second Address | New York, NY 10022-6526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2012 |
Last Update Date | 15/03/2017 |