Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 26NR06081400 | NJ |
NPI | 1023147196 |
---|---|
Provider Name | Mrs. Esther D. Baxam-Spence |
First Address | Durham, NC 27705-2505 |
Second Address | Montclair, NJ 07042-4837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0065099 | (05) | NJ |
20-2932173 | AETNA (01) | NJ |