Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F-350252 | NY |
NPI | 1265694392 |
---|---|
Provider Name | Tram Mai Dang |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 09/05/2015 |