Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401050 | NY |
NPI | 1023272739 |
---|---|
Provider Name | Mrs. Marion Claire Creasap |
First Address | Bronx, NY 10471-2217 |
Second Address | New York, NY 10010-5011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 11/07/2008 |