Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 303918 | NY |
NPI | 1003455676 |
---|---|
Provider Name | Ms. Melanie Ryan Duerr |
First Address | Keene Valley, NY 12943-1806 |
Second Address | Mineville, NY 12956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2019 |
Last Update Date | 31/12/2019 |