Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00664000 | NJ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00664000 | NJ |
NPI | 1003362195 |
---|---|
Provider Name | Lindsay Elizabeth Kellogg |
First Address | Hillsborough, NJ 08844-1528 |
Second Address | Randolph, NJ 07869-1925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 31/03/2017 |