Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F301733 | NY |
NPI | 1023137551 |
---|---|
Provider Name | Miss Tammy Elizabeth Engle |
First Address | Constantia, NY 13044-2608 |
Second Address | Oswego, NY 13126-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 23/08/2014 |