Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AG03190066 | NY |
NPI | 1023641974 |
---|---|
Provider Name | Ms. Nordea Eloina Harrison-Bailey |
First Address | Central Islip, NY 11722-4001 |
Second Address | Southold, NY 11971-4750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2020 |
Last Update Date | 19/02/2020 |