Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R201095 | MD |
NPI | 1003363854 |
---|---|
Provider Name | Kathryn Kloss |
First Address | Nottingham, MD 21236-5908 |
Second Address | Nottingham, MD 21236-5908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 08/09/2016 |