Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 340189 | NY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP127819 | TX |
NPI | 1003200965 |
---|---|
Provider Name | Mrs. Ashley Rae Noboa |
First Address | Bronx, NY 10467-2801 |
Second Address | Bronx, NY 10467-2403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 26/07/2021 |