Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 421510 | NY |
NPI | 1083383285 |
---|---|
Provider Name | Sarah Jane Mango |
First Address | New York, NY 10019-1429 |
Second Address | New York, NY 10019-1429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2021 |
Last Update Date | 23/09/2021 |