Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0024168019 | VA |
NPI | 1013152784 |
---|---|
Provider Name | Kim Rae Guastella |
First Address | Baltimore, MD 21297-1334 |
Second Address | Leesburg, VA 20176-1701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2008 |
Last Update Date | 26/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013152784 | (05) | FL |
1013152784 | (05) | VA |