Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R191846 | MD |
NPI | 1003307471 |
---|---|
Provider Name | Kirsi Johanna Hadley |
First Address | Joppa, MD 21085-1410 |
Second Address | Joppa, MD 21085-1410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2018 |
Last Update Date | 22/05/2018 |