Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | F340391-1 | NY |
NPI | 1083731590 |
---|---|
Provider Name | Ms. Ruth E Knecht |
First Address | Howard Beach, NY 11414-1342 |
Second Address | Brooklyn, NY 11220-4718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 15/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03158665 | (05) | NY |