Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 421419 | NY |
NPI | 1073152831 |
---|---|
Provider Name | Elizabeth Kern |
First Address | Burlington, VT 05401-3805 |
Second Address | Albany, NY 12208-3835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2019 |
Last Update Date | 26/12/2019 |