Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 17700 | LA |
Y | 207YP0228X | Pediatric Otolaryngology | ME113095 | FL |
NPI | 1306867320 |
---|---|
Provider Name | Evelyn A. Kluka |
First Address | Rockland, DE 19732-0191 |
Second Address | Pensacola, FL 32504-8785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1385808 | (05) | LA |
B63921 | (02) |