Provider Demographics
NPI:1144993080
Name:PEDIATRIC NURSE PRACTITIONER, PLLC
Entity type:Organization
Organization Name:PEDIATRIC NURSE PRACTITIONER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPNP
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:BEVERLY
Authorized Official - Last Name:STENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:646-784-6449
Mailing Address - Street 1:2944 HOLIDAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4825
Mailing Address - Country:US
Mailing Address - Phone:646-784-6449
Mailing Address - Fax:516-809-9855
Practice Address - Street 1:2944 HOLIDAY PARK DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4825
Practice Address - Country:US
Practice Address - Phone:646-784-6449
Practice Address - Fax:516-809-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty