Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 21311 | OK |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 35.086978 | OH |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 87-117 | NM |
N | 208G00000X | Cardiothoracic Vascular Surgeon | A52104 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | C-6860 | AR |
N | 208G00000X | Cardiothoracic Vascular Surgeon | K8795 | TX |
NPI | 1023051513 |
---|---|
Provider Name | Dr. Leah Jane Mckinnon |
First Address | Albuquerque, NM 87102-2512 |
Second Address | Albuquerque, NM 87102-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 13/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10077340A | (05) | OK |
E47700 | (02) | OK |