Healthcare Provider Details

I. General information

NPI: 1225305873
Provider Name (Legal Business Name): DAISY FRANCES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 - 5TH AVENUE
BROOKLYN NY
11209
US

IV. Provider business mailing address

7404 - 5TH AVENUE
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-5111
  • Fax: 866-790-3506
Mailing address:
  • Phone: 718-439-5111
  • Fax: 866-790-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: