Provider Demographics
NPI:1194345504
Name:DEE, MIRIAM ANNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ANNE
Last Name:DEE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:ANNE
Other - Last Name:DEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:73 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3714
Mailing Address - Country:US
Mailing Address - Phone:516-377-3332
Mailing Address - Fax:516-377-3844
Practice Address - Street 1:73 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3714
Practice Address - Country:US
Practice Address - Phone:516-377-3332
Practice Address - Fax:516-377-3844
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty