Healthcare Provider Details

I. General information

NPI: 1164076808
Provider Name (Legal Business Name): LAKITRA LADD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE LEVY PLACE
NEW YORK NY
10029-1002
US

IV. Provider business mailing address

1 GUSTAVE LEVY PLACE CARDIO THORACIC UNIT GP 5 CENTER
NEW YORK NY
10029-4701
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: