Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 5008884 | NC |
NPI | 1023567716 |
---|---|
Provider Name | Mrs. Emily Herrick Kassam |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87110-7644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2016 |
Last Update Date | 27/05/2021 |