Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 05002 | TX |
NPI | 1063584084 |
---|---|
Provider Name | Ms. Jennifer Laureen Kelleher |
First Address | Boerne, TX 78006-2603 |
Second Address | Boerne, TX 78006-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |