Individual
MI JIN DOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
114 CLINTON ST, BINGHAMTON, NY 13905-2212
(607) 797-0680
Mailing address
114 CLINTON ST, BINGHAMTON, NY 13905-2212
(607) 797-0680
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F401609-1
NY
Other
Enumeration date
08/02/2013
Last updated
01/08/2016
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