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 |