Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 40401395 | NY |
NPI | 1033406772 |
---|---|
Provider Name | Ms. Ann Green |
First Address | Yonkers, NY 10701-1108 |
Second Address | White Plains, NY 10605-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 04/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00355940 | AGENCY MEDICAID # (01) | NY |
1285628552 | AGENCY NPI NUMBER (01) | NY |
WVE061 | AGENCY MEDICARE # (01) | NY |