Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00564600 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00564600 | NJ |
NPI | 1043607658 |
---|---|
Provider Name | Kenya Cannonier |
First Address | Newark, NJ 07112-1854 |
Second Address | Newark, NJ 07112-1854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |