Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 40 401623 | NY |
NPI | 1023459740 |
---|---|
Provider Name | Mrs. Renata Myers |
First Address | Huntington, NY 11743 |
Second Address | Huntington, NY 11743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2013 |
Last Update Date | 21/05/2020 |