Basic Information
| Provider Information | |||||||||
| NPI: | 1649444373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIERAN | ||||||||
| FirstName: | MAURA | ||||||||
| MiddleName: | NOEL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 OLD NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115762146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164846777 | ||||||||
| FaxNumber: | 5164840037 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 OLD NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115762146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164846777 | ||||||||
| FaxNumber: | 5164840037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F304004-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.