Organization
LAVENDER NEW YORK NURSE PRACTITIONER IN PSYCHIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIGHID GANNON (CEO)
(855) 444-7258
Entity
Organization
Contact information
Practice address
245 5TH AVE FL 3, NEW YORK, NY 10016-8728
(855) 444-7258
Mailing address
22406 68TH AVE W, MOUNTLAKE TERRACE, WA 98043-2372
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/24/2026
Last updated
02/24/2026
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