Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F320095-01 | NY |
NPI | 1154947307 |
---|---|
Provider Name | Ms. Desiree Janell Darrisaw |
First Address | Bronx, NY 10455-2217 |
Second Address | Bronx, NY 10455-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2020 |
Last Update Date | 24/06/2020 |