Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F000341 | NY |
NPI | 1144761107 |
---|---|
Provider Name | Dr. Kathleen Marie King |
First Address | Syracuse, NY 13210-1687 |
Second Address | Syracuse, NY 13215-2265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2017 |
Last Update Date | 10/03/2017 |