Individual
MIRLINE FERTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 S GATE, MASSAPEQUA, NY 11758-4324
(516) 643-4266
Mailing address
1 S GATE, MASSAPEQUA, NY 11758-4324
(516) 643-4266
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F308948-1
NY
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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