Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2018000857 | MO |
Y | 207Q00000X | Family Doctor | 25MA08886900 | NJ |
NPI | 1003109828 |
---|---|
Provider Name | Elisabeth Anacius |
First Address | Flemington, NJ 08822-4603 |
Second Address | Flemington, NJ 08822-4603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 06/12/2021 |