Individual
EDITH KUDADZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2564 WILSON AVE, BRONX, NY 10469-5609
(347) 231-0401
Mailing address
2564 WILSON AVE, BRONX, NY 10469-5609
(347) 231-0401
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F347607
NY
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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