Individual
ETHELYN SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
270-05 76TH AVENUE, NEW HYDE PARK, NY 11040
(718) 470-5370
Mailing address
270-05 76TH AVENUE, NEW HYDE PARK, NY 11040
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
585086-1
NY
363LA2100X
Acute Care Nurse Practitioner
Primary
F430738-1
NY
Other
Enumeration date
09/26/2013
Last updated
06/19/2019
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