Individual
NINA E PEGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
10 GRAHAM RD W, ITHACA, NY 14850-1055
(607) 257-2188
(607) 266-7341
Mailing address
10 GRAHAM RD W, ITHACA, NY 14850-1055
(607) 257-2188
(607) 266-7341
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
L-56399
—
363LP0200X
Pediatric Nurse Practitioner
Primary
382280
NY
Other
Enumeration date
04/18/2012
Last updated
05/06/2020
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