Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1543 | AR |
NPI | 1346350741 |
---|---|
Provider Name | Anna Kahn |
First Address | Harrison, AR 72601-2116 |
Second Address | Harrison, AR 72601-2116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H0835370 | (02) | AR |