Individual
QUIERA DECOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
632 WILSON AVE, BROOKLYN, NY 11207-1577
(631) 578-3547
Mailing address
632 WILSON AVE, BROOKLYN, NY 11207-1577
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
756685
NY
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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