Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 212079 | MA |
NPI | 1073127544 |
---|---|
Provider Name | Stacy E Garrity |
First Address | New York, NY 10012 |
Second Address | New York, NY 10012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 02/09/2020 |