Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP011905 | PA |
NPI | 1043456213 |
---|---|
Provider Name | Mrs. Kyana Anthony |
First Address | Philadelphia, PA 19146-1613 |
Second Address | Philadelphia, PA 19146-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2008 |
Last Update Date | 08/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102236169 | (05) | PA |