Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 469155 | CA |
NPI | 1013060144 |
---|---|
Provider Name | Kathleen Alice Kinrade |
First Address | Lakewood, CA 90713-3036 |
Second Address | Cypress, CA 90630-5805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2007 |
Last Update Date | 27/07/2007 |