Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F336966-1 | NY |
NPI | 1063782688 |
---|---|
Provider Name | Mrs. Sara Isabel Devita |
First Address | Wantagh, NY 11793-4527 |
Second Address | Wantagh, NY 11793-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2012 |
Last Update Date | 12/01/2012 |