Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382266 | NY |
NPI | 1003173873 |
---|---|
Provider Name | Mrs. Julie Anne Chelouche |
First Address | New York, NY 10025-6450 |
Second Address | New York, NY 10025-6450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 30/10/2012 |