| Doctor Name: | MRS. JODI LYNN KANZINGER |
| NPI Number: | 1003060765 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | UP006916C |
| Business Practice Address: | 130 S Bryn Mawr Ave Suite H321 Bryn Mawr, PA - 190103121 |
| Business Phone Number: | 4843374097 |
| Business Fax Number: | 4843374086 |
| Mailing Address: | 130 S Bryn Mawr Ave, Suite H321 BRYN MAWR |
| State: | PA |
| Postal Code: | 190103121 |
| Phone Number: | 4843374097 |
| Fax Number: | 4843374086 |
| NPI Enumeration Date: | 11/07/2008 |
| NPI Last Update Date: | 11/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | UP006916C |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |