Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 001456 | NY |
NPI | 1003199746 |
---|---|
Provider Name | Ms. Odessa Fynn |
First Address | Bronx, NY 10461-1138 |
Second Address | Bronx, NY 10461-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2011 |
Last Update Date | 26/05/2015 |