Individual
MRS. GINETTE THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-5112
Mailing address
683 HALF HOLLOW RD, DIX HILLS, NY 11746-6232
(631) 254-2841
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
301226
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F-301437
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02612104
—
NY
Enumeration date
04/17/2007
Last updated
09/18/2015
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