Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00618200 | NJ |
NPI | 1083086334 |
---|---|
Provider Name | Ms. Khristine Gail Vendiola |
First Address | Wayne, NJ 07470-2149 |
Second Address | Wayne, NJ 07470-2149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2015 |
Last Update Date | 10/02/2016 |