Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | F340161-1 | NY |
NPI | 1073578712 |
---|---|
Provider Name | Mrs. Vanessa Lee Spivey-Burke |
First Address | Deer Park, NY 11729 |
Second Address | Northport, NY 11768-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 11/05/2010 |