Individual
JANINE DALISTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
113 SEABOARD LN STE 200B, FRANKLIN, TN 37067-8282
(855) 292-7957
Mailing address
1055 OAK RIDGE DR, VICTOR, NY 14564-9414
(585) 465-7464
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
708439
NY
363LF0000X
Family Nurse Practitioner
Primary
352337
NY
Other
Enumeration date
11/21/2019
Last updated
12/04/2023
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