Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | ARNP1750042 | FL |
NPI | 1003068552 |
---|---|
Provider Name | Wanda Laverne Mcgowan-Braynen |
First Address | Miami Gardens, FL 33169-2526 |
Second Address | Miami, FL 33136-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 15/10/2008 |