Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F320009 | NY |
NPI | 1043301815 |
---|---|
Provider Name | Ms. Heather Elizabeth Guinan-Clark |
First Address | Middletown, NY 10941-4028 |
Second Address | Middletown, NY 10941-4028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 17/03/2017 |