Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F310299-01 | NY |
NPI | 1013684042 |
---|---|
Provider Name | Patricia Edwards-Graham |
First Address | Brooklyn, NY 11234-1616 |
Second Address | Brooklyn, NY 11209-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 21/01/2022 |