Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME124960 | FL |
NPI | 1043417769 |
---|---|
Provider Name | Dr. Kathryn Diana Convers |
First Address | Valrico, FL 33596-6305 |
Second Address | Lakeland, FL 33813-1671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 02/08/2019 |