Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F309076 | NY |
NPI | 1013563543 |
---|---|
Provider Name | Molly Mckenzie Anderson |
First Address | New York, NY 10027-5250 |
Second Address | New York, NY 10027-5250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 21/08/2019 |