Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | TMW7 | FL |
NPI | 1063838613 |
---|---|
Provider Name | Kendra Ippel |
First Address | Orlando, FL 32803-3313 |
Second Address | Winter Garden, FL 34787-3596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2014 |
Last Update Date | 06/03/2014 |