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MRS. MIRIAM LEE PENNISE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
340 VETERANS HWY STE 12, COMMACK, NY 11725-4300
(631) 486-8400
(631) 486-8080
Mailing address
340 VETERANS HWY STE 12, COMMACK, NY 11725-4300
(631) 486-8400
(631) 486-8080

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
301536 NP
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
379-297 RN
NY

Other

Enumeration date
09/19/2006
Last updated
12/06/2021
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