Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F380735 | NY |
NPI | 1003961848 |
---|---|
Provider Name | Susan Hamill |
First Address | Peekskill, NY 10566-2913 |
Second Address | Coram, NY 11727-4411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02377695 | (05) | NY |
P10377 | (02) | NY |