| NPI | 1871057646 |
|---|---|
| Former Name | KELLIANNE KIM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 1997184) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018343) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-01-20 |