Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382679 | NY |
NPI | 1003340969 |
---|---|
Provider Name | Mrs. Lys Claudie Perard |
First Address | Saint Albans, NY 11412-2306 |
Second Address | Saint Albans, NY 11412-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 18/04/2017 |