Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MA07750000 | NJ |
NPI | 1023008802 |
---|---|
Provider Name | Dr. Kerri Kansas |
First Address | Voorhees, NJ 08043-3518 |
Second Address | Voorhees, NJ 08043-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0039144 | (05) | NJ |