Provider Demographics
NPI:1003034398
Name:CHIU, MISTY L (FNP)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:L
Last Name:CHIU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:L
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PARK AVE, 4 W
Mailing Address - Street 2:HOPE CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703
Mailing Address - Country:US
Mailing Address - Phone:914-964-7723
Mailing Address - Fax:914-964-7321
Practice Address - Street 1:2 PARK AVE, 4 W
Practice Address - Street 2:HOPE CENTER
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703
Practice Address - Country:US
Practice Address - Phone:914-964-7723
Practice Address - Fax:914-964-7321
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY561968163WM0705X
NYF335140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical