Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F347279-01 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | F347279 | NY |
NPI | 1043975337 |
---|---|
Provider Name | Rosa Miller |
First Address | Staten Island, NY 10314-6302 |
Second Address | Staten Island, NY 10314-6302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2021 |
Last Update Date | 02/11/2021 |