Individual
MISS CASSANDRA PROVILUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
450 E 26TH ST, PH, BROOKLYN, NY 11226-7711
(347) 469-5018
Mailing address
450 E 26TH ST, PH, BROOKLYN, NY 11226-7711
(347) 469-5018
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309088-1
NY
Other
Enumeration date
06/12/2014
Last updated
06/12/2014
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