Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | F350400 | NY |
NPI | 1174077119 |
---|---|
Provider Name | Ms. Maria Ines Dela Rosa Legarda |
First Address | Maywood, NJ 07607-2032 |
Second Address | New York, NY 10016-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 08/08/2016 |