Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | NY F340638-1 | NY |
NPI | 1033129036 |
---|---|
Provider Name | Sharon Ann Rayball |
First Address | Latham, NY 12110-5519 |
Second Address | Albany, NY 12208-3410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q53506 | (02) | FL |