Individual
MISS SUPAPORN PATHUMANON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
814 LARCHMONT ACRES APT D, LARCHMONT, NY 10538-7370
(347) 845-1857
Mailing address
814 LARCHMONT ACRES APT D, LARCHMONT, NY 10538-7370
(347) 845-1857
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
738012
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F406141-01
NY
Other
Enumeration date
05/12/2023
Last updated
03/16/2026
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