Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | F420647-1 | NY |
NPI | 1053514091 |
---|---|
Provider Name | Sandra Diane Fields |
First Address | New Rochelle, NY 10801 |
Second Address | New Rochelle, NY 10801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NPP000 | (02) | NY |