Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 43430855 | NY |
NPI | 1043613912 |
---|---|
Provider Name | Ms. Deborah Bennett |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 17/03/2021 |