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1609599307
KAYLA EMILY PROVENZANO
RIVERHEAD, NY
NPI
1609599307
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner Family
(Licence: NY 350411)
Enumeration Date
2022-09-19
Last Update Date
2022-09-19
Business Address
KAYLA EMILY PROVENZANO FNP
1272 E MAIN ST
RIVERHEAD, NY 11901-2583
Phone number: 631-284-3797
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Mailing Address
KAYLA EMILY PROVENZANO FNP
137 DAWN DR
CENTEREACH, NY 11720-2243
Phone number:
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