Individual
DARDA DETERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6744 190 LANE, FLUSHING, NY 11365-0000
(718) 454-2818
Mailing address
6744 190 LANE, FLUSHING, NY 11365-0000
(718) 454-2818
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
4298041
NY
Other
Enumeration date
07/07/2010
Last updated
07/07/2010
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