Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 307256 | NY |
NPI | 1023402690 |
---|---|
Provider Name | Samantha Noelle Morreale |
First Address | Niagara Falls, NY 14304-1251 |
Second Address | Niagara Falls, NY 14304-1251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 24/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
307256 | NEW YORK STATE LICENSE (01) | NY |