Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F382120-1 | NY |
NPI | 1043536808 |
---|---|
Provider Name | Miss Nicole Vanessa Baron |
First Address | Brooklyn, NY 11201-4623 |
Second Address | New York, NY 10032-3725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 07/07/2015 |