Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME70370 | FL |
NPI | 1003858614 |
---|---|
Provider Name | Jeanette Kostell |
First Address | Maitland, FL 32751-7274 |
Second Address | Rockledge, FL 32955-2828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 15/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31970 | BCBS (01) | FL |