Individual
JACLYN BASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RN, CPNP
Contact information
Practice address
19 BRADHURST AVE, SUITE 1400, HAWTHORNE, NY 10532-2140
(914) 493-7997
(914) 594-4022
Mailing address
PO BOX 1020, HAWTHORNE, NY 10532-7507
(888) 633-0033
(914) 593-1802
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
382226
NY
Other
Enumeration date
01/10/2015
Last updated
07/29/2015
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