Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F400779 | NY |
NPI | 1013357946 |
---|---|
Provider Name | Mrs. Joann Marie Basile |
First Address | Brentwood, NY 11717-4625 |
Second Address | Brentwood, NY 11717-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 25/06/2013 |