Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | RN211195 | GA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN211195 | GA |
NPI | 1144739111 |
---|---|
Provider Name | Elizabeth Louise Farrell Oppenheim |
First Address | Decatur, GA 30033-2934 |
Second Address | Atlanta, GA 30309-1281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 22/10/2018 |