Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 42-420272 | NY |
NPI | 1043527880 |
---|---|
Provider Name | Ms. Sophronia Larig |
First Address | Brooklyn, NY 11231-3465 |
Second Address | Brooklyn, NY 11231-3465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 31/08/2010 |