Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 340959 | NY |
NPI | 1003341850 |
---|---|
Provider Name | Viletha Small-Clarke |
First Address | Brooklyn, NY 11203 |
Second Address | Brooklyn, NY 11203-4505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2017 |
Last Update Date | 28/04/2017 |