Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401651 | NY |
NPI | 1023450343 |
---|---|
Provider Name | Prof. Anne Marie Peters |
First Address | Island Park, NY 11558-1707 |
Second Address | Island Park, NY 11558-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 07/10/2013 |