Individual
LARA BETH WAHLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
462 1ST AVE, NEW YORK, NY 10016-9196
(212) 562-5278
Mailing address
508 E 78TH ST, APT 2-M, NEW YORK, NY 10075-8800
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
F307409-1
NY
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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