Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 338923 | NY |
NPI | 1073995569 |
---|---|
Provider Name | Ms. Carrie Li |
First Address | Jamaica, NY 11432-1121 |
Second Address | Jamaica, NY 11432-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 22/06/2015 |