Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2018005851 | MO |
NPI | 1003335803 |
---|---|
Provider Name | Ajanta Jinhee Raman |
First Address | Kansas City, MO 64108-2677 |
Second Address | Kansas City, MO 64108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
420056229 | (05) | MO |