Individual
MIJA HA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21763 77TH AVE, BAYSIDE, NY 11364-3024
(917) 588-6962
Mailing address
21763 77TH AVE, BAYSIDE, NY 11364-3024
(917) 588-6962
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F310736
NY
Other
Enumeration date
08/04/2022
Last updated
08/04/2022
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