Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NNO7977200 | NJ |
NPI | 1033112859 |
---|---|
Provider Name | Ms. Kathy O Covert |
First Address | Manville, NJ 08835-2243 |
Second Address | New Brunswick, NJ 08901-1766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 19/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P74928 | (02) | NJ |