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Organization

GREAT WATER LAND SERVICES NURSE PRACTITIONER IN PSYCHIATRY PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JILL RYAN RN MSN PHMNP-C (NURSE PRACTITIONER)
(516) 695-0389
Entity
Organization

Contact information

Practice address
166 EUCLID AVE, MASSAPEQUA, NY 11758-4207
(516) 695-0389
(956) 253-4627
Mailing address
166 EUCLID AVE, MASSAPEQUA, NY 11758-4207
(516) 695-0389
(956) 253-4627

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
10/08/2024
Last updated
10/08/2024
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