Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 3822115 | NY |
NPI | 1003086745 |
---|---|
Provider Name | Shirley Schue |
First Address | Cooperstown, NY 13326-1301 |
Second Address | Cooperstown, NY 13326-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 01/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302032100 | (05) | FL |