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Individual
PHANESSA JEAN
Active
Individual
PHANESSA JEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
674084
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
403156
NY
Other
Enumeration date
01/08/2014
Last updated
10/06/2020
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