Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 350409 | NY |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 35-350409 | NY |
NPI | 1174075774 |
---|---|
Provider Name | Mrs. Sarah Jane Tyner |
First Address | Baldwinsville, NY 13027-9350 |
Second Address | Baldwinsville, NY 13027-9350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2016 |
Last Update Date | 12/12/2016 |