Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F339003 | NY |
NPI | 1003222159 |
---|---|
Provider Name | Rita Lynn All |
First Address | Queensbury, NY 12804-7880 |
Second Address | Fort Edward, NY 12828-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03922272 | (05) | NY |