| NPI | 1801202445 |
|---|---|
| Former Name | KIMBERLY JO POREMBA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3325) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 7918) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2023-05-04 |