Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP016542 | PA |
NPI | 1003363235 |
---|---|
Provider Name | Catherine Kazanjian |
First Address | Bala Cynwyd, PA 19004-1508 |
Second Address | Bala Cynwyd, PA 19004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 03/08/2018 |