Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NN04297000 | NJ |
NPI | 1003840448 |
---|---|
Provider Name | Kathleen Stanier |
First Address | Sunrise, FL 33323-2851 |
Second Address | Long Branch, NJ 07740-6303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 27/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8746605 | (05) | NJ |
P24292 | (02) |