Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 340697 | NY |
NPI | 1003367038 |
---|---|
Provider Name | Sarah Dunham |
First Address | Utica, NY 13501 |
Second Address | Utica, NY 13502-4801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2016 |
Last Update Date | 27/02/2020 |