Mauricio Vergara
Nurse Practitioner, Adult Health in Lynbrook, NY. Individual provider (NPI-1).
NPI number1831966985
StatusActive
Last updated in NPPESDec 8, 2023
Details
- NPI
- 1831966985
- Entity type
- Individual (NPI-1)
- Name
- Mauricio Vergara
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 8, 2023
- Certification date
- Dec 8, 2023
- Last updated
- Dec 8, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2200X | Nurse Practitioner, Adult Health | 311550 | NY | Yes |
| 363LG0600X | Nurse Practitioner, Gerontology | 311550 | NY |
Practice location
67 Chestnut StLynbrook, NY 11563-1838
Phone 917-612-4401
Mailing address
67 Chestnut StLynbrook, NY 11563-1838
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