Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ01169800 | NJ |
NPI | 1003581745 |
---|---|
Provider Name | Yesica Cano |
First Address | West Orange, NJ 07052-2750 |
Second Address | West Orange, NJ 07052-2750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2021 |
Last Update Date | 13/08/2021 |