Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 003355 | CT |
NPI | 1063476851 |
---|---|
Provider Name | Maki S Jerden |
First Address | Sandy Springs, GA 30350-2051 |
Second Address | Sandy Springs, GA 30350-2051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 21/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004258671 | (05) | CT |
Q65186 | (02) | CT |