Individual
JESSICA SANTOS PACANNUAYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121A WEST 20TH STREET, NEW YORK, NY 10011
(212) 337-9284
(212) 337-9275
Mailing address
2815 33RD ST, APT. 1R, ASTORIA, NY 11102-1379
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401561
NY
Other
Enumeration date
02/25/2013
Last updated
03/28/2014
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