Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71010164A | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71010164A | IN |
NPI | 1013535129 |
---|---|
Provider Name | Holly M Kieda |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46250-2042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 10/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300040813 | (05) | IN |