Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 350505 | NY |
NPI | 1003421033 |
---|---|
Provider Name | Ms. Kelly N Miles |
First Address | Albany, NY 12208-3478 |
Second Address | Albany, NY 12208-3478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 16/09/2020 |