Individual
JOMELYN BERNADETTE PROVIDO SIOSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9428 57TH AVE, ELMHURST, NY 11373-5147
(917) 497-9159
Mailing address
9428 57TH AVE, ELMHURST, NY 11373-5147
(917) 497-9159
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
760314
NY
Other
Enumeration date
06/04/2024
Last updated
06/04/2024
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