| NPI | 1316654353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEDA ANGELINA PORT Owner 212-961-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2023-03-30 |