Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00674500 | NJ |
NPI | 1023553468 |
---|---|
Provider Name | Ms. Corinne Desevo |
First Address | Tinton Falls, NJ 07701-4964 |
Second Address | Tinton Falls, NJ 07701-4964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2016 |
Last Update Date | 20/12/2016 |