Individual
MISS DASSETTA GOODHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4383 BYRON AVE, PH, BRONX, NY 10466-1516
(646) 260-9710
Mailing address
4383 BYRON AVE, PH, BRONX, NY 10466-1516
(646) 260-9710
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
291485-1
NY
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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