Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401907-1 | NY |
NPI | 1033573068 |
---|---|
Provider Name | Vivian Nwuba |
First Address | Selden, NY 11784-4403 |
Second Address | Selden, NY 11784-4403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 06/04/2016 |