Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00460300 | NJ |
NPI | 1003241498 |
---|---|
Provider Name | Khalena F Anselmo |
First Address | Sea Girt, NJ 08750-2805 |
Second Address | Sea Girt, NJ 08750-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 19/09/2013 |