Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F421097-1 | NY |
NPI | 1053662064 |
---|---|
Provider Name | Sophie B Peltzer-Rollo |
First Address | High Falls, NY 12440-0071 |
Second Address | Poughkeepsie, NY 12601-4165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2012 |
Last Update Date | 01/10/2012 |