PHYLLIS PROVOST

HAUPPAUGE, NY
NPI1972656783
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy163WP0808X Registered Nurse, Psych/Mental Health
(Licence: NY  270668-1)
Enumeration Date2007-01-18
Last Update Date2007-07-08
Business Address
Ms. PHYLLIS PROVOST APRN
750 VETERANS HWY
HAUPPAUGE, NY 11788-2943
Phone number: 631-724-5522
Mailing Address
Ms. PHYLLIS PROVOST APRN
77 RIDGE RD
SOUTHAMPTON, NY 11968-3608
Phone number: 631-724-5522
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