Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 25ME00012001 | NJ |
NPI | 1114036803 |
---|---|
Provider Name | Ms. Ellen Ann O'neill |
First Address | Kearny, NJ 07032-3113 |
Second Address | Jersey City, NJ 07306-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1479601 | (05) | NJ |