Provider Demographics
NPI:1386726602
Name:KAO, EVA J (NP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:J
Last Name:KAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1294
Mailing Address - Country:US
Mailing Address - Phone:856-310-0042
Mailing Address - Fax:856-310-0092
Practice Address - Street 1:2 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1294
Practice Address - Country:US
Practice Address - Phone:856-310-0042
Practice Address - Fax:856-310-0092
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00026700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0034754Medicaid
NJ078018Medicare ID - Type Unspecified