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Organization
GREAT WATER LAND SERVICES NURSE PRACTITIONER IN PSYCHIATRY PLLC
Active
Organization
GREAT WATER LAND SERVICES NURSE PRACTITIONER IN PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL RYAN RN MSN PHMNP-C (NURSE PRACTITIONER)
(516) 695-0389
Entity
Organization
Contact information
Practice address
166 EUCLID AVE, MASSAPEQUA, NY 11758-4207
(516) 695-0389
(956) 253-4627
Mailing address
166 EUCLID AVE, MASSAPEQUA, NY 11758-4207
(516) 695-0389
(956) 253-4627
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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