Individual
CLOVER DEER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1124 E 86TH ST, BROOKLYN, NY 11236-4737
(917) 543-0324
Mailing address
1124 E 86TH ST, BROOKLYN, NY 11236-4737
(917) 543-0324
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
664115
NY
363LW0102X
Women's Health Nurse Practitioner
421525
NY
Other
Enumeration date
06/19/2023
Last updated
02/24/2025
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