Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F403011 | NY |
NPI | 1013503010 |
---|---|
Provider Name | Tatyana Poviliunas |
First Address | Queensbury, NY 12804-5882 |
Second Address | Queensbury, NY 12804-5882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2020 |
Last Update Date | 19/12/2020 |