Individual
MRS. DANIELLE ALBERTE GUSTAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
45 E 81ST ST, NEW YORK, NY 10028-0263
(212) 737-9774
Mailing address
13152 232ND ST, LAURELTON, NY 11413-1836
(646) 377-0096
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
545039
NY
363LA2200X
Adult Health Nurse Practitioner
307698
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402807
NY
Other
Enumeration date
08/17/2017
Last updated
11/22/2019
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