Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F300040 | NY |
NPI | 1013025774 |
---|---|
Provider Name | Susan P. Nalle |
First Address | Fulton, NY 13069-1228 |
Second Address | Oswego, NY 13126-3276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S93604 | (02) | NY |