Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00053200 | NJ |
NPI | 1013069277 |
---|---|
Provider Name | Mrs. Kelli Ann Lennon |
First Address | Highlands, NJ 07732 |
Second Address | Long Branch, NJ 07740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |