Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | F340737-1 | NY |
NPI | 1003113630 |
---|---|
Provider Name | Mrs. Muriel S Brown |
First Address | Hammondsport, NY 14840-9320 |
Second Address | Bath, NY 14810-0810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2011 |
Last Update Date | 17/02/2011 |