Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RO76919 | MD |
NPI | 1073615191 |
---|---|
Provider Name | Diane Kershow Hanlon |
First Address | Chester, MD 21619-2824 |
Second Address | Baltimore, MD 21201-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RO76919 | NURSING LICENSE (01) | MD |