Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 018462-23-05 | NH |
NPI | 1013110576 |
---|---|
Provider Name | Mrs. Mary Kathryn Kazanowski |
First Address | Bedford, NH 03110-5025 |
Second Address | Raymond, NH 03077-1710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |