Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901018465 | MI |
N | 122300000X | Dentist | P-123 | LA |
N | 1223P0106X | Oral and Maxillofacial Pathology | 2901018465 | MI |
Y | 1223P0106X | Oral and Maxillofacial Pathology | P-123 | LA |
NPI | 1558494559 |
---|---|
Provider Name | Kitrina G Cordell |
First Address | New Orleans, LA 70119-2714 |
Second Address | New Orleans, LA 70119-2714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 23/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1958112200 | BCBS OF MI MED SURGICAL (01) | MI |
4500641 | (05) | MI |
4874070 | (05) | MI |
D184650 | BCBS OF MI DENTAL (01) | MI |
U18873 | (02) | MI |