Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 420316 | NY |
NPI | 1023237070 |
---|---|
Provider Name | Ms. Ellen Mctigue |
First Address | Brooklyn, NY 11226 |
Second Address | Brooklyn, NY 11226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |