Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 171405 | GA |
N | 363LW0102X | Nurse Practitioner - Women's Health | 420933 | NY |
NPI | 1033346747 |
---|---|
Provider Name | Ms. Isla Starr Marrero |
First Address | Atlanta, GA 31107-0702 |
Second Address | Duluth, GA 30096-7612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2009 |
Last Update Date | 06/04/2016 |