Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 466308-1 | NY |
NPI | 1003863424 |
---|---|
Provider Name | Sandra Brown-Truter |
First Address | Long Island City, NY 11106-5121 |
Second Address | Hauppauge, NY 11788-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 07/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q55807 | (02) |