Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382386 | NY |
NPI | 1043491525 |
---|---|
Provider Name | Mrs. Hannah Marie Pizza |
First Address | Cooperstown, NY 13326-1301 |
Second Address | Cooperstown, NY 13326-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2007 |
Last Update Date | 24/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02898108 | (05) | NY |