Individual
CHIQUITA IRVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 E MAPLE AVE, NEWARK, NY 14513-1949
(315) 879-7780
Mailing address
201 E MAPLE AVE, NEWARK, NY 14513-1949
(315) 879-7780
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
293157-1
NY
Other
Enumeration date
08/26/2015
Last updated
08/26/2015
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