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General NPI Number Information
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NPI Number | 1841019049
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Entity Type | Organization
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Legal Business Name | RADIANCE WELLNESS NP IN FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 674 DOGWOOD AVE
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-3247
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Country | US
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Telephone | 631-796-1888
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Fax | 929-290-0328
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Provider Business Mailing Address
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Address Line | 674 DOGWOOD AVE
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-3247
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Country | US
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Telephone | 631-796-1888
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Fax | 929-290-0328
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | SERGINA JEAN
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Credential | NP
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Telephone | 631-796-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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