Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | F001504-1 | NY |
NPI | 1063661973 |
---|---|
Provider Name | Ms. Laurie Jane Brucia |
First Address | Brooklyn, NY 11206 |
Second Address | Brooklyn, NY 11206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 18/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000425800 | (05) | FL |