Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1100036 | KY |
NPI | 1285856625 |
---|---|
Provider Name | Amber M Missi |
First Address | Louisville, KY 40202-1835 |
Second Address | Louisville, KY 40202-1835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1100036 | STATE LICENSE (01) | KY |