Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 255406 | NY |
NPI | 1023015856 |
---|---|
Provider Name | Mrs. Marie Oquendo-Miller |
First Address | Coram, NY 11727-2039 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 08/07/2007 |