Individual
EDWIDGE D DESGRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
129 JACKSON ST, HEMPSTEAD, NY 11550-2412
(212) 695-5122
Mailing address
997 HUCKLEBERRY RD, NORTH BELLMORE, NY 11710-1913
(516) 610-7071
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
309713
NY
Other
Enumeration date
08/03/2020
Last updated
08/03/2020
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