Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301099426 | MI |
NPI | 1093090458 |
---|---|
Provider Name | Dr. Candace Johnson Kimpson |
First Address | Detroit, MI 48226-1732 |
Second Address | Detroit, MI 48235-2624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2011 |
Last Update Date | 25/08/2021 |