Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001904 | NY |
NPI | 1093286692 |
---|---|
Provider Name | Ms. Kaia Marissa Ross-Duggan |
First Address | Brooklyn, NY 11210-1534 |
Second Address | Brooklyn, NY 11210-1534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2018 |
Last Update Date | 08/12/2018 |