Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F420361 | NY |
NPI | 1023008224 |
---|---|
Provider Name | Mrs. Eleanor Mellon Dunham |
First Address | Southampton, NY 11968-3956 |
Second Address | Southampton, NY 11968-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 02/04/2010 |