Doctor Name: | ITI KANSAL |
NPI Number: | 1588021299 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | RN223738 |
Business Practice Address: | 138 W Gibson St Hartwell, GA - 306431847 |
Business Phone Number: | 7063766200 |
Business Fax Number: | |
Mailing Address: | 1061 Dowdy Rd Ste 100, ATHENS |
State: | GA |
Postal Code: | 306065700 |
Phone Number: | 7066217575 |
Fax Number: | |
NPI Enumeration Date: | 01/26/2016 |
NPI Last Update Date: | 01/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN223738 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |