Individual
ETHY CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
302 W 148TH ST APT 3A, NEW YORK, NY 10039-2927
(646) 714-5511
Mailing address
302 W 148TH ST APT 3A, NEW YORK, NY 10039-2927
(646) 714-5511
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
423223
NY
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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