Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F420129-1 | NY |
NPI | 1003035551 |
---|---|
Provider Name | Ms. Brenda Dawn Slade |
First Address | New York, NY 10025-3422 |
Second Address | New York, NY 10027-6905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |