Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F346097 | NY |
N | 363LG0600X | Nurse Practitioner - Gerontology | F346097 | NY |
NPI | 1023626793 |
---|---|
Provider Name | Naomi L Mehmedovic |
First Address | Liverpool, NY 13090-1086 |
Second Address | Liverpool, NY 13090-1086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2020 |
Last Update Date | 20/07/2020 |