Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F304283 | NY |
NPI | 1013099811 |
---|---|
Provider Name | Wilma P George |
First Address | East Syracuse, NY 13057-9248 |
Second Address | East Syracuse, NY 13057-9248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |