Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F306952-1 | NY |
NPI | 1053729616 |
---|---|
Provider Name | Ms. Johanna Maggio |
First Address | New York, NY 10035-4337 |
Second Address | New York, NY 10035-4337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2014 |
Last Update Date | 28/07/2014 |