Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ01135700 | NJ |
NPI | 1043899966 |
---|---|
Provider Name | Yanet Montiel Garnica |
First Address | West New York, NJ 07093-4688 |
Second Address | Jersey City, NJ 07302-4397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2021 |
Last Update Date | 07/04/2021 |