NPI | 1538708003 |
---|---|
Former Name | KIMBERLY ANN TITAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 263215) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209020467) |
Enumeration Date | 2020-01-02 |
Last Update Date | 2022-11-15 |