Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 38-382215 | NY |
NPI | 1033478656 |
---|---|
Provider Name | Mrs. Simone Alicia Belle |
First Address | Jamaica, NY 11418-2832 |
Second Address | Jamaica, NY 11418-2832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 05/02/2016 |