Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Dec 5, 2007
License(s)
549801 (NY), 381769 (NY), 381769 (NY), 549801 (NY), 370047 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 161 FORT WASHINGTON AVE | New York, NY 10032-3729 | 212-305-0527 |
| MAILING | 630 W 168TH ST BOX 4 | New York, NY 10032-3725 | 212-342-5155 |
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