Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AG0514061 | NY |
NPI | 1003225152 |
---|---|
Provider Name | Sophia Palmer |
First Address | Amityville, NY 11701-1016 |
Second Address | Amityville, NY 11701-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2014 |
Last Update Date | 21/01/2016 |