Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 26NJ00343100 | NJ |
NPI | 1063781482 |
---|---|
Provider Name | Mrs. Kristin Jay Leahy |
First Address | Highlands, NJ 07732-1565 |
Second Address | Highlands, NJ 07732-1565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2011 |
Last Update Date | 14/12/2011 |