Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | NJ00166700 | NJ |
NPI | 1043449077 |
---|---|
Provider Name | Jenica M Kolb |
First Address | Camden, NJ 08103-1438 |
Second Address | Camden, NJ 08103-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 13/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NJ00215100 | MEDICAL LICENSE (01) | NJ |