Basic Information
| Provider Information | |||||||||
| NPI: | 1417037748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRESTON | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | HANORA | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 E 48TH ST APT 9G | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100172184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314024997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 EAST 42ND STREET BTWN. 3RD AND LEXINGTON | ||||||||
| Address2: | MINUTE CLINIC | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126618139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 11/19/2018 | ||||||||
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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 | 363LF0000X | 336975 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 414828784 | 01 | NY | NY DRIVERS LICENSE | OTHER |