NPI | 1295184059 |
---|---|
Former Name | VANESSA REILLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402299) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 674658) |
Enumeration Date | 2016-06-11 |
Last Update Date | 2022-03-15 |