Individual
MISTY SIOSON LALIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2840 WELLMAN AVE FL 1, BRONX, NY 10461-5583
(917) 773-7910
Mailing address
2840 WELLMAN AVE FL 1, BRONX, NY 10461-5583
(917) 773-7910
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
612376
NY
Other
Enumeration date
06/09/2023
Last updated
06/09/2023
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