Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 340361 | NY |
NPI | 1013247824 |
---|---|
Provider Name | Mrs. Nereida Borrero |
First Address | Staten Island, NY 10304-4523 |
Second Address | Staten Island, NY 10305-3436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2009 |
Last Update Date | 30/12/2009 |