Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Oct 30, 2024
License(s)
F355300-01 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 6120 GRAND CENTRAL PKWY APT B1106 | Forest Hills, NY 11375-1254 | |
| LOCATION | 11037 70TH RD | Forest Hills, NY 11375-3933 | 347-514-1406 |
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