| NPI | 1518595727 |
|---|---|
| Doing Business As | LAVENDER |
| Entity Type | Organization |
| Authorized Contact | BRIGHID GANNON Owner 718-757-0684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-02-03 |