Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 01061837A | IN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 04-32504 | KS |
NPI | 1164575601 |
---|---|
Provider Name | Jakica Tancabelic |
First Address | Topeka, KS 66606-1535 |
Second Address | Topeka, KS 66606-1535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 12/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200425220B | (05) | KS |
KA2129019 | MEDICARE PTAN (01) | KS |