| NPI | 1740590363 |
|---|---|
| Former Name | KIMBERLY CAROL BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 9856) |
| Additional Taxonomies | 364SC2300X Clinical Nurse Specialist, Chronic Care (Licence: CA 245) |
| Enumeration Date | 2010-10-16 |
| Last Update Date | 2010-10-16 |