Healthcare Provider Details

I. General information

NPI: 1164958807
Provider Name (Legal Business Name): BRIANNA VIXAMA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAMARONECK AVE
HARRISON NY
10528-1633
US

IV. Provider business mailing address

500 MAMARONECK AVE
HARRISON NY
10528-1633
US

V. Phone/Fax

Practice location:
  • Phone: 914-771-7373
  • Fax:
Mailing address:
  • Phone: 914-771-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: