Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305149-1 | NY |
NPI | 1023341187 |
---|---|
Provider Name | Tanya Sullivan |
First Address | New York, NY 10026-2585 |
Second Address | Ny, NY 10029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2009 |
Last Update Date | 08/09/2009 |