Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 19800 | MS |
N | 207U00000X | Nuclear Medicine Specialist | 36071489 | IL |
N | 207U00000X | Nuclear Medicine Specialist | C52110 | CA |
N | 207U00000X | Nuclear Medicine Specialist | L5169 | TX |
NPI | 1245330935 |
---|---|
Provider Name | Vani Vijayakumar |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00050780 | (05) | MS |
149847901 | (05) | TX |
F32763 | (02) | |
P00436436 | RAILROAD MEDICARE (01) | MS |
P01620197 | RAILROAD MEDICARE PTAN (01) | MS |