Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | UP006916C | PA |
NPI | 1003060765 |
---|---|
Provider Name | Mrs. Jodi Lynn Kanzinger |
First Address | Bryn Mawr, PA 19010-3121 |
Second Address | Bryn Mawr, PA 19010-3121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2008 |
Last Update Date | 02/11/2015 |