Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1139470 | KY |
NPI | 1003153776 |
---|---|
Provider Name | Aimee Christine Mihalyov |
First Address | Louisville, KY 40214-2777 |
Second Address | Louisville, KY 40202-1740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2013 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100305660 | (05) | KY |