Individual
CLARISSA ANN SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 689-8333
Mailing address
19801 100TH AVE, HOLLIS, NY 11423-3315
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F308908-1
NY
Other
Enumeration date
02/13/2019
Last updated
03/22/2019
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