Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 0532787 | KS |
Y | 207RH0003X | Hematology & Oncology | 2004013306 | MO |
NPI | 1033312996 |
---|---|
Provider Name | Jerilyn Hart |
First Address | Saint Louis, MO 63150-4407 |
Second Address | Kansas City, MO 64111-5961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 11/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205475908 | (05) | MO |